Archived: Carlton House

Updated 26 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This service is in special measures and has been kept under review. This was a comprehensive inspection that took place as part of that review to see if improvements had been made.

Before our inspection we reviewed the information we held about the service which included any statutory notifications we had received in the last 12 months, communications with the local authority and healthcare professionals.

Two inspectors undertook the inspection which took place on 13, 20 and 21 March 2018. The first day was unannounced. At the end of the first day we told the provider we would be returning to continue with our inspection.

We spoke with four people who used the service, two staff members, both deputy managers and the registered manager. We conducted observations throughout the inspection. We looked at seven people’s care records, three staff records and other documents which related to the management of the service, such as training records and policies and procedures.

Updated 26 July 2018

Our inspection took place on 13, 20, 21 March 2018 and was unannounced. At the end of the first day we told the provider we would be returning to continue with our inspection.

Carlton House is a residential care service that is currently registered to provide housing and personal support for up to 15 adults who have a range of needs including mental health and learning disabilities. On the first day of our inspection 10 people were using the service but three people were in hospital. On the second day of our inspection a fourth person was admitted to hospital.

The service had a registered manager in post. 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 2008 and associated Regulations about how the service is run.

Previously, we carried out an unannounced comprehensive inspection of this service on 2 and 3 February 2016. A breach of legal requirement was found in relation to staff training. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. We undertook a focused inspection on 16 June 2016 and found the provider had met the legal requirements.

In March 2017 the local authority contacted us because they had concerns with health and safety issues at a neighbouring property which was also being used to accommodate people. They were also worried about how the service treated people who lacked the capacity to make decisions about their care and treatment.

We undertook a focused inspection on the 23 March 2017. We had not been aware the provider was using the neighbouring property. We found four breaches of legal requirements in relation to safety of the premises and of people using the service, how people gave consent to care and records relating to this, how the service was managed and a failure to notify CQC of specific incidents. The provider was rated as inadequate in two key questions, safe and well led. The provider sent us a plan to tell us about the actions they were going to take to rectify each breach of the regulations. They told us these would be completed between May and July 2017.

Following this inspection in March 2017 CQC began to investigate concerns about the registration of Carlton House. We were concerned the provider may not have been registered properly and may have been providing care outside of our regulated activities. This meant we were unable to inspect the service to make sure people were receiving the care they should have. We took action and met with the provider to make sure they understood how serious the situation was. We asked them to provide us with information to clarify their registration position. During this period we worked with the local authority to ensure people remained safe. The provider’s registration is now correct and they are registered with us as a partnership.

We carried out a comprehensive inspection in October 2017 to make sure the provider had met the legal requirements found during our last visit. At this inspection provider confirmed the neighbouring property was no longer in use. We checked this during our visit. The provider told us they were applying to reduce the number of bed numbers at the service from15 to12 to reflect their existing position. This had not been completed yet and the service is still registered to accommodate 15 people even though it no longer has the capacity to do this.

During our inspection in October 2017, we found 10 breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The breaches related to safe care and treatment, the need for consent, good governance, safeguarding, person centred care, staffing, failure to display a rating, requirements relating to a registered manager, premises and equipment and dignity and respect. The service continued to be in breach of the four regulations found in March 2017.

During this inspection in March 2018 we found a continued eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The breaches continued to relate to safe care and treatment, the need for consent, good governance, safeguarding, person centred care, requirements relating to a registered manager, premises and equipment and dignity and respect.

The service continued to be in breach of the four regulations found in March 2017 We found the provider had improved in two areas, staffing and failure to display a rating and had met the legal requirements in these areas. While we were conducting this inspection we met with the external consultant who had been employed by the provider, in February 2018, to help the service make improvements.

We are considering what action we will take in relation to these breaches. Full information about the CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Work had started on updating the risk assessments for one person. Other risk assessments and care plans continued to be out of date and, some risks to people had not been identified concerning peoples individual needs. Environmental risk was high. We found risks relating to excessive hot water in people’s rooms and communal bathrooms. The risk had been noted but nothing had been done to keep people safe.

The service was not clean. People's rooms were dirty and in need of essential maintenance. There were no records of cleaning schedules for people's rooms and tasks were allocated to staff verbally so the provider was unable to evidence how they monitored the hygiene and cleanliness of the service.

The mix and number of people using the service and the new layout of the rooms continued to give us concerns about the number of toilets and bathing facilities available and accessible for people. Men and women used the service and moving from floor to floor to use bath shower rooms and toilets impacted on people’s dignity and privacy.

There continued to be issues with people’s medicine records. Information was still not available to staff to explain how people liked to take their medicine. Only one person’s medicine profile was complete. This gave important information about the person, any allergies and the type of medicine they were taking. Staff were not checked to see if they continued to give people their medicines safely.

Staff we spoke with knew about safeguarding people from abuse and neglect but we were concerned because the provider had failed to report, act upon and investigate some incidents.

The service was not working within the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people’s rights were protected. Only one person had a mental capacity assessment in place. There was confusion and lack of documentation around DoLS applications and a general lack of understanding had placed people at unnecessary risk.

There continued to be some concerns with people’s healthcare needs. When people’s health needs changed these were not always acted on. When healthcare professionals gave advice this was not always followed. The service had begun to record the choice people were offered for food and drinks but when people needed extra support with their nutrition their care records did not reflect this and the risk had not been identified.

We saw activities taking place at the service and people having access to the community. We were still concerned activities may be limited for some people who were less mobile. People had activity plans but there were no records of the activities people had taken part in so we were unable to confirm if sustainable improvements had been made.

The service continued to be poorly led. Systems were not in place to identify health and safety issues that could put people who used the service and staff at risk. There were no robust systems to check the quality of the service.

The registered manager had continue to fail to ensure care plans and risk assessments were up to date and accurate and when people lacked capacity to make some decisions there were no checks in place to ensure the correct legislation and guidance had been followed.

We continued to find the registered manager did not have the skills and competency to carry out her role.

After our last inspection the registered manager had told CQC about some important incidents that had occurred concerning people who used the service. However, we found incidents at not been recorded properly and we remain concerned about the lack of reporting to CQC.

The service had made improvements with staff training and staff had started to receive regular supervision to support them to carry out their duties. People were relaxed in the company of staff. Staff appeared to know people well although this knowledge was only reflected in some people’s care plans.

The overall rating for this service remains ‘Inadequate’ and the service is therefore still in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will