The inspection was carried out on 22 May 2018, 4 June 2018 and 18 June 2018 and was unannounced on all three days. We had previously inspected the home in May 2017 and rated it as requires improvement.

Carlton Lodge is a 'care home' for up to 10 adults needing support with their mental health needs or who have a learning disability including people on the autism spectrum.. At the time of the inspection there were nine people in the home. People in care homes receive accommodation and nursing or personal care as a single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was no registered manager in post, but there was a newly appointed manager who said they would be registering with the Care Quality Commission. 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.

We identified eight breaches in the regulations relating to person centred care, dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, staffing and good governance.

The Registered Provider was not working within the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service did not live as ordinary life as any citizen.

We found staffing levels were not sufficient to meet people's needs and this impacted throughout people's care and support. We saw many occasions where people were unsupervised despite known risks to their safety and well-being. There were risks, such as fire safety and vehicle safety, which were not addressed.

People said or indicated they did not feel safe or happy in the home. People were not adequately safeguarded and there was evidence of restraint being used without suitable measures in place to ensure people’s rights and safety were promoted. There was no clear accountability for people’s finances and no systems to prevent financial abuse. People's mental capacity was not thoroughly assessed. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

Accidents and incidents were not consistently recorded and there was insufficient oversight or monitoring to identify where lessons could be learned.

Staff, with the exception of a few, had a poor approach to interacting with people. People's dignity was compromised and staff did not support them respectfully. There was a complete lack of person centred care and little meaningful activity taking place. People were not involved in planning their care and they had little choice or input into the quality of their life at Carlton Lodge. People’s complaints were not taken seriously.

The home was not well run or managed and there was a lack of leadership and direction for staff. There were insufficient systems in place to ensure people received appropriate standards of care or to drive improvement.

The overall rating for this service is 'Inadequate' and the service has therefore been placed 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

The inspection of Carlton Lodge took place on 8 May 2017 and was unannounced. The home was previously inspected in March 2015 and rated good overall with requiring improvement in the responsive domain due to a lack of available activities for people to engage with. There were no breaches of regulations at this previous inspection.

Carlton Lodge is a converted property in a suburban street which provides care and support for ten adults needing support with their mental health needs or who have a learning disability including people on the autism spectrum. There were nine people in the home on the day we inspected as one person was away from the service.

There was a registered manager in post and we spoke with them on the day of the inspection. They were also registered to manage two other properties owned by the same provider and shared their time between all three. 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.

Staff had a sound understanding of how to deal with more complex behaviour and knew what may be seen as abuse. They were confident in how to report such concerns and we saw evidence of appropriate referrals to the local authority.

Risks were not always managed in a person-centred manner and assessments were often generic. We found assessments had not been updated often enough and personal emergency evacuation plans were not reflective of current need.

Staffing levels meant people’s needs were met in a timely manner and staff had time to spend with people. Medication was administered, stored and recorded appropriately.

The ongoing refurbishment of the home meant the communal lounge was not conducive to offering a homely environment but we saw this was work in progress. The dining room and some other communal areas had been redesigned sensitively and appropriately.

People’s nutritional and hydration needs were supported where this was necessary, and staff encouraged people to make healthy choices. Health and social care support was accessed as required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, although this was seen in practice, records did not always evidence best interest decision-making.

Staff had received an induction, one to one supervision and training which ensured they were equipped to support people well.

We observed staff to be patient, kind and caring with people. They paid attention to the smallest of details and promoted people’s dignity and privacy.

Care records were in the process of being updated and reviewed. Staff were being trained to complete these reviews. Most contained good descriptions of people’s individual needs and how these were to be met.

Complaints were handled well with apologies given to people where standards had fallen short.

The registered manager had clearly made an impact and made some significant progress in altering the culture of the home. However, they acknowledged there was still more to be done and had developed an action plan as evidence of this. The quality assurance systems needed further development to ensure they provided an accurate reflection of the support being provided for people.

We found two breaches of regulations relating to the need for consent and safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

The inspection of Carlton Lodge took place on 4 March 2015 and was unannounced. This was the first inspection for this service under Section 60 of the Health and Social Care Act 2008.

Carlton Lodge is a converted property which provides care and support for ten adults with a learning disability. The home is in a suburban street and is only a short journey from local shops and amenities.

The service 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe. People’s records contained risk assessments to ensure their care and support was planned and delivered in a way that reduced risks to their safety and welfare.

We saw there was a system in place to ensure the premises and equipment were adequately maintained to provide a safe environment for staff and the people who lived at the home. We saw that much of the home required redecorating, the registered manager assured us a plan was in place to refurbish much of the home.

There were enough staff to meet people’s needs and there was a system in place to cover any short term staff absence.

The system for managing people’s medicines was safe. Staff told us they had received training in a variety of subjects including medicines management.

Systems to support people to manage their money were individualised, there was also a system in place to protect people from the risk of their money not being handled effectively. People we spoke with told us how staff supported them to access their money as they needed it.

The cook was knowledgeable about people’s preferences and people who lived at the home spoke positively about their meals.

The home was a converted property and there was limited communal space. People had single bedrooms which each contained a washbasin, there was access to a spacious communal bathroom on both floors.

During our inspection we did not witness any interaction between people and/or staff that gave us any cause for concern. However, one person we spoke with told us that sometimes staff did not speak appropriately to people.

Not all the people who lived at the home had the support of family or friends. One person we spoke with said they would like to have an advocate. We asked the registered manager if this could be arranged.

Some of the people we spoke with told us they had a key to their bedroom door. Bathroom doors also had locks on to ensure people could have privacy if they wished.

People we spoke with told us about the activities they participated in, however, they also told us they were bored and there was not enough to occupy them. Peoples care records detailed the activities they had participated in and the care and support they required.

The registered manager told us the service had not received any complaints.

People and staff spoke positively about the registered manager and told us they were able to report any concerns they may have to her. The registered manager was knowledgeable about people’s needs and she was visible to people who lived at the home.

People’s views and opinions were gathered and listened to. Regular staff and resident meetings were held and an annual quality feedback survey was conducted.

Systems for auditing the quality of service provision were in place.