We carried out a focused inspection on 06 March 2018 in response to concerning information about poor and unsafe care and treatment relating to poor manual handling techniques, concerns about medicines administration, lack of staff deployed resulting in people getting up to early and poor hygiene practices. This report only covers our findings in relation to the key questions, ‘Is the service safe?’ and ‘Is the service well-led?’

Carlton House Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Carlton House Rest Home accommodates 40 people in one adapted building. Accommodation at the home is provided over three floors. There are two lounges on the ground floor and a small family lounge on the second floor. The dining room is on the ground floor and there is a passenger lift to all floors. At the time of the inspection 33 people were using the service.

There was a registered manager in place. 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 and associated Regulations about how the service is run.

People felt safe living at Carlton House Rest Home. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

There were arrangements in place for managing medicines. However further work was required on the recording of the administration of ‘when required’ (PRN) medicines.

The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.

There were appropriate management arrangements in place. Regular audits of the service were carried out to assess and monitor the quality of the service.

The inspection took place on 13 and 16 March 2017 and was unannounced.

Carlton House Rest Home is registered with the Care Quality Commission to provide care for up to 40 older people, some of whom may be living with dementia. There were 36 people using the service at the time of our inspection. The home is situated close to the town centre of New Milton with level access to local shops and public amenities. The accommodation is over three floors. There are two lounges on the ground floor and a small, family lounge on the second floor. The dining room is on the ground floor and there is a passenger lift to all floors.

The home had a registered manager in place. 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 our last inspection in January 2015 we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, in relation to medicine management. During this inspection we reviewed what actions the provider had taken to improve the service. We saw that improvements had been made to the safe management of medicines. We found that further improvements could be made to the auditing of medicines and controlled drugs. When we discussed this with the provider they took immediate action to review, amend and initiate a new audit tool to improve the safe management of medicines.

People told us that they felt safe. Staff knew how to safeguard people from potential abuse and how to raise any concerns appropriately.

People's needs had been identified and the risks associated with people's care and support had been assessed and managed. Where risks had been identified these had been minimised to better protect people's health and welfare.

Staff were recruited safely and records demonstrated appropriate checks were undertaken to ensure staff were suitable for the role they were employed to undertake. There were enough staff deployed to meet the care and support needs of the people living in the home.

The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People had sufficient to eat and drink and were supported to maintain a balanced diet. They had access to a range of healthcare professionals and services.

Staff had received an induction into the service. The provider had provided staff with appropriate support through supervisions, appraisals, and training.

People were looked after by kind and caring staff who knew them well. They were supported to express their views and to be involved in all aspects of their care. People were treated with dignity and respect.

Staff told us the registered manager demonstrated a strong and supportive leadership. The culture of the service was open, transparent and progressive.

Complaints policies and procedures were in place and were available to people and visitors. People told us they were confident that they could raise concerns or complaints and that these would be dealt with accordingly.

The inspection of Carlton House Rest Home took place unannounced on 9 January 2015. Carlton House is a care home for up to 40 older people, including those who may be living with dementia, a mental health disorder or a physical disability. There were 34 people living at the home when we inspected.

Carlton House Rest Home is located in New Milton, Hampshire, in a residential area close to the town centre. The accommodation is over three floors and most bedrooms are ensuite. The home has two lounges on the ground floor and a small, family lounge on the second floor. The dining room is on the ground floor and there is a passenger lift. At the front of the house, there is an enclosed garden with a patio area.

The home has a registered manager. 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 and associated Regulations about how the service is run.

Medicines were not always managed safely and there was a risk people might not receive the right medicines at the right time.

There were also some safety precautions, relating to emergency planning that were not in place, which could put people and staff at risk.

People living at the home and their visitors and relatives were complimentary about the quality of care provided. They liked the friendliness of staff, and the homely atmosphere. We were told staff encouraged people to treat Carlton House as their home.

Staff suitability for working at the home was checked during recruitment. Risks associated with people’s wellbeing were identified and managed, with steps taken to keep people safe from harm. The home was staffed with enough care staff to meet people’s individual needs and staff received training relevant to their roles.

People were cared for by staff who knew and respected people’s specific preferences and needs. Staff demonstrated a caring and friendly manner with people and recognised when people needed additional support. Care was personalised so people chose what they wanted to do or eat and staff respected people’s choices.

The home was well led. The registered manager made herself available to staff, visitors and people using the service and provided visible leadership. Management and staff at the home worked effectively with health and social care professionals and followed their advice when delivering people’s care.

People’s care plans provided guidance on how they wished to be supported and people were involved in making decisions about their care. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005, and relates to promoting people’s rights to freedom of movement. The registered manager followed the requirements of the act and was progressing DoLS procedures where appropriate.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, in relation to medicine management. You can see what action we told the provider to take at the back of the full version of the report.

We were assisted by the manager throughout the inspection. We spoke with six people who lived at the home and with two visiting relatives. Some people were able to tell us about their experience of living at Carlton House whilst others were not able to give a good account of their experiences because of a diagnosis of dementia. We carried out a SOFI to assist us in understanding the experiences of these people. We were able to speak with two relatives who were visiting Carlton House at the time of our inspection. We also spoke with four members of staff.

From our observations we saw that people’s care and welfare needs were met on the day of our inspection. We also saw within people’s records that their needs had been assessed before they entered the home and care plans had been put in place to meet people’s needs.

We found people’s nutritional needs had been assessed and they were weighed regularly. The home provided people with a balanced and nutritious diet. People who lost weight were appropriately referred to their GP and action taken.

The home had robust recruitment procedures in place that were followed. All of the required checks and records to evidence this were in place.

The home was well managed with systems in place to make sure that the quality of service was monitored.

We were assisted by the registered manager and Nominated Individual throughout the inspection and spoke with seven people living at the home. Some of these people were able to tell us about their experience of living at Carlton House but others not, owing to dementia. We therefore carried out a SOFI. We were able to speak with two relatives visiting the time of our inspection and with three members of the staff team.

We observed throughout the inspection people were treated with respect and dignity. One person able to give a good account of what it was like to live at the home told us, ‘The staff are very kind, I really like them all’. One relative commented that whenever she visited, she observed that people seemed very at ease with the staff. People told us that the food was of a very good standard and that there was plenty of choice. They also told us that should they need to ring their call bell, the staff answered promptly.

People’s health and welfare needs were met by a well trained staff team. People’s care plans were up to date and concisely informed care workers how to meet people’s assessed needs. Relatives told us that people were always presented nicely with clean clothes and that the home was clean and free from unpleasant odours.

We found that the home was well managed with systems in place to make sure that the quality of service was monitored.