CQC report explained · a residential care home
What the CQC found at Carlton Drive Short Breaks Service
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, safe recruitment checks, up-to-date risk assessments and medicines records that were completed correctly. Staff knew how to report abuse, accidents and incidents.
- Effective?
- Good
- People's needs and choices were assessed before their stay. Staff had training and support, and people received help with food, drink, healthcare and communication.
- Caring?
- Good
- Staff were kind, respectful and familiar with people's preferences. People were offered choices, and their privacy, dignity, cultural needs and beliefs were respected.
- Responsive?
- Good
- Care plans reflected people's needs, interests and communication methods. People could choose activities, maintain family relationships and raise complaints, which the home had managed appropriately.
- Well-led?
- Good
- Inspectors found approachable managers, an open culture and systems for checking care quality. The home sought feedback and had a plan for further improvements.
What inspectors found, October 2019
Rated Good; inspectors found kind, safe and personalised care, with some further medicines and emergency planning improvements identified.
This was an unannounced inspection. The inspector visited the home on 14 October 2019 and spoke to relatives by telephone on 15 October. They observed care, spoke with people, relatives and staff, and checked care, medicines, recruitment and management records.
The home provided short stays for people with learning disabilities, autism, physical disabilities and sensory impairment. Inspectors found enough staff, safe medicines systems, suitable risk assessments and clean surroundings. People were supported to make choices, eat and drink well, use health services and take part in activities.
Inspectors found staff to be kind and respectful. Care plans were personalised and regularly reviewed. Relatives felt confident in the care and knew how to raise concerns. The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led.
The previous inspection was also rated Good. Since then, the home had increased the number of people it could support at one time from six to seven. Further improvements to medicines processes were planned, and information about people's wishes in a medical emergency or at the end of life was still to be collected.
Kind and respectful staff
People had positive relationships with staff who knew their preferences and treated them with dignity. Relatives said staff were caring and trustworthy.
“People received care from staff that were kind, caring and compassionate.” from the report
Personalised support
Care plans included people's routines, likes, dislikes, communication needs and interests. Reviews took place before each stay so support could be updated.
“People and relatives were fully involved in writing the first draft of people's care plan” from the report
Good activities and choice
People could choose meals and activities, use the day service and go out into the community. The home also supported contact with family and friends.
“People were supported to maintain relationships with family and friends, there were no restrictions on visiting.” from the report
Strong knowledge of health and dietary needs
Staff understood individual allergies and dietary requirements, including cultural and religious needs. They worked with health professionals and relatives when people's health changed.
“We found staff had an exceptional knowledge of people's dietary requirements and allergies and ensured people's needs were met during their stay.” from the report
Medicines processes still being improved
minorMedicines were found to be managed safely, but the provider had planned further improvements to reduce the risk of errors. Ask what has changed since the inspection.
“Further improvements were planned to the medicines systems and processes, to further reduce the risk of medicines errors.” from the report
Emergency and end-of-life information
minorPeople did not receive end-of-life care at the home. However, the manager planned to gather people's preferences and wishes for a medical emergency or end-of-life situation.
“They planned to collate information regarding people's preferences and wishes should there be a medical emergency or people reach the end of their lives.” from the report
- 01What changes have been made to the medicines systems since the inspection, and how do you check for errors?
- 02How will you record my relative's wishes if they have a medical emergency or reach the end of life?
- 03How will staffing and individual support be managed now that the home can support seven people at one time?
- 04How will you learn about my relative's routines, communication needs, dietary requirements and preferred activities before their first stay?
- 05How will you keep families informed about what happened during each short break?
This was an unannounced inspection covering the premises, care and all five CQC questions, with observations, interviews and records checks; the visit took place on 14 October and relatives were contacted on 15 October 2019. This explanation was written from the published report of 25 October 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2017
Carlton Drive Short Breaks Service was rated Good; inspectors found kind, safe and personalised care, with some records needing improvement.
The inspection was unannounced and took place on 21 March 2017. One inspector spoke with people, relatives, staff and a social care professional. They observed care and checked care records, medicines records, staff files and the home’s management records.
The home supported up to six adults with physical and learning disabilities for short stays. Four people were using it during the visit. Inspectors found that people were safe, received effective support and were treated with kindness and respect.
Care was based on people’s preferences, communication needs and interests. Relatives were involved in planning stays, and people could take part in activities they enjoyed. The home had systems for listening to feedback, handling complaints and checking the quality of care.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. The home remained Good, matching its rating at the previous inspection in August 2014.
Kind and respectful care
Staff were described as compassionate and kind. Inspectors saw staff protecting people’s dignity and privacy.
“We saw that staff protected people's dignity and privacy.” from the report
Personalised support
Staff knew people well and followed their routines, preferences and communication needs. People were encouraged to keep their skills and independence.
“People had support plans centred on them as individuals.” from the report
Suitable staffing and recruitment
Inspectors found enough staff to meet people’s needs and found that recruitment checks had been completed.
“We found that the provider had followed its procedures to safely recruit new staff members. This included checks on their suitability.” from the report
Activities and choice
People could take part in activities they enjoyed and were supported to access the local area. Staff adapted support to individual interests.
“People had opportunities to take part in activities that they enjoyed.” from the report
Open management
The manager and provider gathered feedback, responded to complaints and carried out checks to improve the service.
“The registered manager and provider carried out checks on the quality of the service to drive improvements.” from the report
Bruising records
needs fixingRecords showed that small bruises found when two people arrived were recorded, but the action taken to investigate them was not always documented.
“The recording of small bruises found when two people arrived at the service occurred but the action taken to investigate these was not always noted.” from the report
Medicine change records
needs fixingOne person’s medicine record did not always clearly explain why the medicine routine had changed. The manager said staff would be reminded to record changes clearly.
“One person's medicine record was not always clear about the reasons for a change to their medicines routine.” from the report
Some support plans were out of date
needs fixingSome people’s support plans contained old information. The manager was reviewing and updating them where needed.
“The registered manager explained that some people's support plans were being reviewed as they contained out of date information.” from the report
- 01How do you now record and investigate bruising found when someone arrives for a short stay?
- 02How do you make sure changes to medicines are clearly explained in the medicine records?
- 03How do you check that each person’s support plan is up to date before every stay?
- 04How will you find out about my relative’s preferences, communication needs and health changes before their first visit?
- 05What activities and opportunities for independence could you offer my relative during a short stay?
This was an unannounced comprehensive inspection covering all five areas, based on observations, discussions with people and relatives, and checks of care, medicines, staff and management records. This explanation was written from the published report of 26 April 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Carlton Drive Short Breaks Service
3 rated inspections over 5 years: the service has held its Good rating throughout.
- October 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Carlton Drive Short Breaks Service →
- April 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Carlton Drive Short Breaks Service →
- April 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 16 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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