This inspection took place on 2 and 9 November 2016. Day one was unannounced and day two was announced. At the last inspection in July 2015 we found the provider was in breach of two regulations; they did not have systems in place to make sure the number of staff and range of skills met the needs of people who used the service and the care provided did not always meet people’s individual needs. At this inspection we found the provider had made improvements which were sufficient to meet regulation.

Carlton House provides care for up to 16 people who have a learning disability. The service had a registered manager. 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.

At this inspection people told us they felt safe. Staff understood safeguarding procedures and were equipped and supported to work with people who displayed behaviours that challenged. The provider had risk management systems which ensured hazards were identified and minimised. This included effective recruitment of workers, health and safety, risk assessment and management of medicines. Some minor issues were identified with medicine administration and dealt with promptly. There were enough staff to meet people’s needs; people who received funding for one to one staff support had allocated workers.

Staff were trained and supervised which ensured they had the skills and knowledge to carry out their job well. Staff and management told us recent improvements had been made which included better support for staff. People could make decisions about their care and support, and whenever they needed help staff provided appropriate support. The provider had arrangements in place to meet people’s nutritional needs and was further developing these to make sure people were actively involved in the menu planning process. Systems were in place to help make sure people stayed healthy.

People told us they enjoyed living at Carlton House and were complimentary about the staff who supported them. We observed staff were caring and friendly, and knew the people they were supporting well. The provider had some accessible information available to help keep people informed, and included how to stay safe, the type of care they can expect and how to raise concerns. However, this was not readily available for everyone; the registered manager agreed to develop systems for accessing information. The provider nominated an ‘employee of the month’ where they recognised good practice.

People’s needs were assessed and support plans clearly identified how staff should deliver care. Regular reviews were held and people spent time with their key worker discussing their care. People had activity programmes which were person centred and provided them with opportunities to engage in varied activities within the home and the community. Communal space within the service was not well utilised and this resulted in people congregating in one main area which sometimes became hectic. People were comfortable talking to staff if they were worried, upset or had any concerns. Complaints were responded to and resolved where possible to the satisfaction of the person.

The provider had an effective management structure in place. We received feedback that recent changes had improved service delivery and staffing arrangements. Checks were carried out by the management team at Carlton House and by senior managers when they visited although it was not clear if all action points were followed up. A new governance monitoring format was being introduced across the sector so everyone would be following the same system. People were given opportunities to share their views at meetings, however, meeting records were not easily accessible a

This inspection took place on 27 July 2015 and was unannounced. At the last inspection in August 2013 we found the provider was meeting the regulations we looked at.

Carlton House provides care for up to 16 males who have a learning disability or a mental health need. At the time of the inspection, the service had a registered manager. 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.

People we spoke with told us they were happy with the care they received and were complimentary about the staff who supported them. They looked well cared for. People were relaxed in the company of staff and others they lived with. Staff interactions were friendly, respectful and caring. Visiting relatives were happy with the standard of care and told us the service was well led.

We observed people who used the service were sitting around for much of the day. Support staff were very busy but were mainly engaged in tasks such as cleaning, cooking and laundry, and often not working directly with people who used the service. People had to wait for staff before they could engage in activities. People enjoyed the food and received good support to make sure their health needs were met.

People’s care and support needs were assessed and plans identified how care should be delivered. However, some concerns were raised by health professionals because staff did not always implement care plans effectively. Sometimes information to help monitor care needs was not being recorded. People consented to care and where a person lacked capacity to make decisions appropriate systems were in place to support them.

Staff understood how to keep people safe and knew the people they were supporting very well. Overall, people were protected against the risks associated with medicines. Two medication issues were identified during the inspection; the deputy manager took prompt action to address these.

Staff received support to help them understand how to deliver appropriate care. Recruitment processes were generally thorough but did not always highlight a mismatch between different pieces of information. The deputy manager discussed a new process that was being introduced and was confident this would identify any future discrepancies.

People got opportunity to comment on the service and influence service delivery. Effective systems were in place to monitor the quality and safety of the service.

We found the home was in breach of regulations 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 the report.

The registered manager was on annual leave at the time of this inspection. We therefore spoke with the deputy manager regarding the service.

We spoke with four people who used the service. All four people told us they had meetings with their key worker to discuss their goals and how they wished to spend their one to one time. One person told us; “I can choose where I want to go and what I want to do.” Another person said; “Staff encourage me to do things for myself.” People told us there were lots of things for them to do. For example, gardening, Zumba, baking and going to college.

People told us they liked living at Carlton House. One person said; “I like living here. I’ve settled in here.” Another said; “I like it here. I don’t want to move.”

We found care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. However, we highlighted to the deputy manager that the care record documentation and review dates could be made clearer. This would help ensure that a change in a person’s needs was not overlooked.

We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw evidence that staff received regular supervisions and there was a system in place to ensure mandatory training was kept up to date. The provider had an effective system to regularly assess and monitor the quality of service that people received.

We spoke with four people who used the service.

The people we spoke with were generally happy living at Carlton House. One person told us; “It’s alright most of the time.” Another person said; “I prefer living here now. It’s much quieter.” Another person commented; "It’s very nice here. There’s lots to do.”

We asked two people whether they were involved with their care and treatment. Both people told us they met regularly with their key worker to discuss their care and treatment. One person said; “If I’m unhappy with anything, I can tell them. You can change things in your care plan if you want.” Another person said their key worker was “very helpful and kind. They go out of their way to help me and on more than one occasion.”

People told us there were plenty of things for them to do and that they could go “out and about” if they wanted. Comments about staff included:

“They are very nice and supportive.”

“The staff understand my condition and are there to help me.”

The people we spoke with told us they felt safe living at Carlton House. People said if they were unhappy with anything they could speak to the staff, the deputy manager or the manager. People commented that they would be listened to.

People who use the service said they can generally make decisions and choices about their care. However some people who use the service were unable to tell us if they can make decisions about their care.

Some of the things people said: “The food is nice”. “It’s very good here”.