CQC report explained · a residential care home
What the CQC found at Carlton House Rest Home Limited
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- People generally felt safe and staff knew how to report abuse. However, some risk assessments lacked detail, emergency lighting checks were not being done monthly, and infection-control procedures and parts of the building needed improvement.
- Effective?
- Good
- This key question was not assessed during this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Caring?
- Good
- This key question was not assessed during this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Responsive?
- Good
- This key question was not assessed during this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Well-led?
- Good
- Management was described as open and approachable. Audits and other systems were used to monitor quality, and feedback from people, relatives, staff and health professionals was sought and acted on.
What inspectors found, December 2022
Carlton House Rest Home Limited: rated Good overall, but Safe required improvement because some safety and infection-control checks were not robust.
This was an unannounced focused inspection on 5 and 11 October 2022. The inspectors looked only at Safe and Well-led because the inspection followed concerns about a safeguarding review. They spoke with people, staff, relatives and health professionals, and checked care, medicine, recruitment and management records.
People generally felt safe and enjoyed living at the home. Staff were available, kind and trained to recognise abuse. Medicines were managed safely, and the home was clean. However, some risk assessments lacked detail, emergency lighting checks had not been done often enough, some staff wore painted nails, and parts of the building needed repair or redecoration.
The overall rating was Good. Safe was rated Requires Improvement, the same as at the previous inspection. Well-led was rated Good, also unchanged. The other three ratings were not inspected during this visit and were carried forward from the previous inspection.
People felt safe
People and relatives told inspectors they felt safe. Staff understood safeguarding and knew how to raise concerns.
“People told us they felt safe living at the home.” from the report
Medicines were managed safely
Medicine records showed people received their medicines as prescribed. The home had moved to an electronic system and had checks for ordering and stock.
“Medicine administration records (MARs) confirmed people had received their medicines as prescribed.” from the report
Responsive staffing
Inspectors saw that staff were not rushed and responded promptly and compassionately. Staffing levels matched the planned target during the inspection.
“We observed that staff were not rushed and responded promptly and compassionately to people's requests for support.” from the report
Open management
Staff and relatives described management as visible, fair and approachable. The home used audits, surveys and feedback to identify and make improvements.
“There were effective systems in place to monitor and improve the quality of the service provided.” from the report
Clean home
People and relatives were happy with the cleanliness of the home, although inspectors identified some infection-control improvements that were still needed.
“Very clean, exceptionally clean, no smells, spotlessly clean.” from the report
Risk assessments lacked detail
needs fixingSome individual risk assessments did not contain enough information to guide staff fully in reducing risks to people.
“However, some of these contained limited information and more details were required to ensure they were robust.” from the report
Infection-control shortfalls
needs fixingInspectors saw some staff wearing painted nails. They also found worn equipment, a bathroom floor needing resealing and waste bins without closed-fitting lids.
“At this inspection we saw some staff with painted nails and spoke to the registered manager about our concerns.” from the report
Emergency lighting checks
needs fixingEmergency lighting checks had been carried out quarterly rather than monthly. The provider said this had been an oversight and planned to correct it.
“However, emergency lighting was being carried out every quarter instead of monthly.” from the report
Employment history checks
needs fixingOne staff file had gaps in employment history, and other files recorded only the year staff left previous jobs. The provider later explored the gaps and agreed to record months as well as years.
“This meant we could not be assured employment gaps had been fully explored to ensure staff were safe to work at the service.” from the report
- 01Have all individual risk assessments been updated with the extra detail inspectors said was needed?
- 02Are emergency lighting checks now being completed monthly, and can you show us the records?
- 03What steps ensure that all staff, including staff who might be asked to provide care in an emergency, follow the rule on painted nails?
- 04Have the bathroom repairs, redecoration and waste-bin improvements identified by inspectors been completed?
- 05How are employment gaps and previous employment dates now checked and recorded for new staff?
This was a focused inspection of Safe and Well-led only; the other three ratings were carried forward from the previous inspection. This explanation was written from the published report of 3 December 2022 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, July 2021
Carlton House Rest Home is rated Good overall, but inspectors found safety systems and medicines records needed improvement.
Inspectors visited unannounced on 19 and 26 May 2021. They spoke with people, relatives, staff and health professionals. They also checked care records, medicines, staff recruitment files and management records.
The home had improved since its previous inspection. People said they felt safe and received kind, person-centred care. Staff were trained, staffing levels were seen as sufficient, and the home was clean. Food, healthcare support and infection control arrangements were viewed positively.
The Safe rating remained Requires Improvement. Some 'as required' medicines were not correctly recorded, leaving some medicines unaccounted for. Recruitment records did not always show full employment histories, and some cleaning and care records were not robust enough. These issues were addressed or started to be addressed during the inspection.
Effective and Well-led were rated Good. The overall rating improved from Requires Improvement to Good. Caring and Responsive were not inspected during this visit, so earlier ratings for those areas were carried forward.
Kind, person-centred care
People and relatives gave positive feedback about the care. Staff supported people respectfully and involved them in choices.
“People received person-centred support and care delivery ensured people were enabled to maintain skills and independence.” from the report
Enough staff
Inspectors saw staff responding promptly and compassionately. People and relatives said staffing levels were sufficient.
“We observed that staff were not rushed and responded promptly and compassionately to people's requests for support.” from the report
Good training and support
Staff had a wide range of training, regular supervision and support from management.
“People were supported by staff who had completed a wide range of training to develop the skills and knowledge they needed to meet people's needs and to understand their roles and responsibilities.” from the report
Clean home and infection measures
The home appeared very clean and had arrangements for testing, PPE, visits and managing COVID-19 risks.
“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report
Positive management culture
Relatives and staff found management approachable and supportive. The service worked with health professionals and kept relatives updated.
“Staff felt supported by the registered manager and found them approachable and caring.” from the report
PRN medicines records
seriousSome medicines prescribed to be given when needed were not recorded correctly. This meant some stock could not be accounted for, although the issue was corrected and an electronic system was introduced.
“However, medicines prescribed 'as and when required'(PRN) were not recorded correctly, which resulted in unaccounted for medicines.” from the report
Recruitment histories
needs fixingStaff suitability checks were completed, but records showed employment histories in years rather than months. This meant the home could not always show a full employment history had been checked.
“However, records of employment history showed years not months, so it was not always possible to be assured that a full employment history had been taken as required by schedule 3 of the Health and Social Care Act 2008.” from the report
Record keeping and audits
needs fixingSome records and audits were not detailed or consistent enough. Examples included cleaning records, food and fluid charts, recruitment files and information about supporting a person whose behaviour challenged others.
“At this inspection we found improvements had been made, however, work was still needed to ensure all audits were being assessed and monitored to provide positive outcomes for people using the service in line with Regulation 17.” from the report
Infection-control practice
needs fixingSome staff were observed with false or painted nails, which inspectors identified as an infection-control risk. The manager acted immediately and this was corrected by the second inspection day.
“However, during the inspection we observed some staff with false or painted nails which is an infection control risk and not in line with current infection control guidance from Public Health England and government guidance relating to COVID-19.” from the report
- 01How has the new electronic medicines system worked since the inspection, and how are PRN medicines now checked?
- 02How do you make sure every new staff member has a complete employment history recorded?
- 03What checks now confirm that cleaning records cover people's rooms and communal areas?
- 04How are food and fluid charts completed and reviewed when someone arrives from hospital or is at risk of losing weight?
- 05How do you record and review support for people whose behaviour may challenge others?
This was a focused inspection prompted by concerns about pre-assessment care plans and food and fluid charts; Safe, Effective and Well-led were inspected, while Caring and Responsive were not inspected and earlier ratings were carried forward. This explanation was written from the published report of 8 July 2021 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 House Rest Home Limited
6 rated inspections over 8 years: the service has held its Good rating throughout.
- December 2022Goodcurrent ratingstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Carlton House Rest Home Limited →
- July 2021Goodup from Requires improvementSafe: Requires improvementWell-led: Good
Read what inspectors found at Carlton House Rest Home Limited →
- January 2020Requires improvementdown from GoodSafe: Requires improvementEffective: GoodWell-led: Requires improvement
- April 2018Goodstayed GoodSafe: GoodWell-led: Good
- May 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2015GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- September 2011
Registered with the Care Quality Commission on 16 September 2011.
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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