The inspection of Carleton Court Care Home took place on 28 February and 2 March 2017 and was unannounced. The home was last inspected during June 2015 and there were no breaches of regulations at the last inspection.

Carleton Court Care home is registered to provide personal care and accommodation for up to 32 older people; some of whom are living with dementia. The home is a converted property providing a number of communal areas on the ground floor, with bedrooms situated on the ground, first and second floors.

One of the directors of the registered provider is also the registered manager of the home. 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 told us they felt safe living at Carleton Court Care Home. The registered manager and staff were aware of relevant procedures to help keep people safe and staff could describe signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Risks to people had been assessed and measures put into place to reduce risk. The building was well maintained and regular safety checks took place.

Medicines were managed, stored and administered safely and appropriately, by staff who had been trained to do so.

Appropriate safe recruitment procedures were followed. Staff told us they felt supported and we saw evidence staff had received appropriate induction, training and ongoing support and supervision.

We observed staff obtained verbal consent from people prior to providing care and support. People’s mental capacity was assessed and we saw decisions were made in some people’s best interests. However, some mental capacity assessments were not decision specific, in accordance with the Mental Capacity Act 2005. Appropriate Deprivation of Liberty Safeguards authorisations had been sought where people were lacking capacity and were being deprived of their liberty in order to receive care and treatment.

People were supported to have 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.

People received appropriate support in order to have their nutritional and hydration needs met. A variety of drinks and snacks were offered to people throughout the day.

We observed staff to be kind and supportive and people told us staff were caring. We observed people’s privacy and dignity was respected. There was a pleasant, relaxed atmosphere in the home.

Care and support was provided in a person centred manner. Care needs were regularly reviewed and people were involved in their care planning. People told us they could make their own choices in relation to their daily lives. Appropriate information was shared between staff to enable continuity of care.

The directors and the registered manager were visible throughout the service during our inspection and they knew people’s needs well. Regular staff meetings and resident meetings were held and the registered manager sought feedback from people.

Regular quality assurance audits were undertaken and the registered manager ensured that, where actions were identified, these were recorded and monitored.

The inspection of Carleton Court Care Home took place on 15 June 2015 and was unannounced. We previously inspected the service on 1 and 2 December 2014 and at that time we found the provider was not meeting the regulations relating to respecting and involving people who use services, management of medicines and assessing and monitoring the quality of service provision. We asked the registered provider to make improvements. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Carleton Court Care Home provides care for a maximum of 32 older people. There were 27 people living at the home when we visited. The home is a converted property providing a number of communal areas on the ground floor with bedrooms situated on the ground and first floor.

The registered provider is also the registered manager for the service. 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 found there were systems in place to ensure people received their medicines safely. In each of the records we looked at we saw risk assessments were in place to reduce the risk of harm to people. There was a system in place to monitor accidents and incidents.

Although the second floor of the home was not occupied by people who lived at the home, the windows on this floor did not have restrictors in place to reduce the risk of falling from height.

There was a system in place to ensure staff received regular training and support. We found new staff were supported when they commenced employment at the home.

The registered provider was aware of their responsibilities under the Mental Capacity Act 2005 and staff had received training about this legislation, although not all the staff we spoke with demonstrated an understanding of how this impacted upon their role.

We observed lunchtime at the home and found the atmosphere to be relaxed, calm and conducive to a positive dining experience.

Every one we spoke with told us staff were kind, caring and respected their privacy and dignity. We observed friendly, professional interactions between staff and people who lived at the home.

Care records were person centred and evidenced the support people needed, however, as information was located in a number of different files, it was not always easy to locate.

People told us they knew how to complain and we saw their was a system in place to monitor and records peoples concerns.

Since our last inspection the registered provider has taken a number of actions to address the issues and concerns we raised. A system has been implemented to assess and monitor the service provided to people however, we found evidence that this system was not yet fully effective. This evidenced people were not always protected from unsafe or inappropriate care as the registered person had not effectively assessed and monitored the quality of services provided.

The registered provider had a system in place to gain the views and opinions of people who lived at the home.

You can see what action we told the provider to take at the back of the full version of the report.

We received information of concern regarding the following:

- GPs were not called out when needed or requested.

- People did not have a nutritional and varied diet.

- People could not choose their bed times.

- Incorrect moving and handling techniques were being used.

- Medication was put into pots and left with people who were incapable of taking them independently.

- Appropriate checks were not being carried out before staff began work.

The registered manager was on leave at the time of our inspection.

Due to the complex needs of people using the service we were not always able to speak to people. To help us understand the experiences of people using the service, we spoke to the relatives of ten people.

Through speaking with relatives of people, speaking with staff and by observation, we found no evidence to suggest that people’s needs had not been met. However, people’s needs were not always reflected in the care records. We found that people’s personal records were not accurate and fit for purpose.

We found people were not provided with a choice of food at lunch time. People were not provided with appropriate assistance to help them express their views and facilitate their involvement in making decisions about their care and treatment.

We found one staff member’s conduct in previous employment had not been obtained prior to this person providing care. Appropriate checks were not undertaken before staff began work.

People told us they enjoy living in the home. One person told us the home is ‘excellent’ and is like living in a ‘five star hotel’. One visiting relative said the home is wonderful and the staff are excellent, they always listen to what they say and keep them informed about the care of their relative.

Another visiting relative told us they are more than happy with the quality of care provided the staff are very good , the bedrooms are lovely and the meals are excellent.

People told us they feel safe and comfortable. Two visitors told us that they visit the home all of the time and they are always made to feel welcome and the staff keep them well supplied with tea and coffee. People living in the home also told us they are treated with dignity at all times and their wishes are respected.

People told us that the staff are always very polite and courteous. One person said the staff are excellent and very caring. One visiting relative said that they are always made to feel at home and nothing is to much trouble.

Three visitors said that they think the home is ‘marvellous’ and the new bedrooms in the extension are very nice. They also said they like the new conservatory lounge and the new garden area. One person living in the home said their new dining room is ‘lovely’ and they like the new dinning room furniture.

Visitors told us they feel supported by the home. One said they are fully involved and have a say in how their relative is cared for. Another said if they have any issues they can discuss this with staff and things get ‘sorted out’ right away.

People told us they feel supported and well cared for. Visitors to the home told us they are very happy with the quality of care and the staff in the home. One person said the staff are always very good and are always polite and courteous.

People say they enjoy living in the home. One person said they have everything they need and the staff are very caring and helpful. Another says they can choose what they want to do and have a choice of meals.

Another person says they particularly enjoy the religious services held in the home as they are a born again Christian. They went on to say that there are not many Christian Care homes about, but this is the best. One relative said they are very pleased with the care provided by the home and they are involved and have a say in what happens to their relative.

One person receiving day care says the home is ‘fantastic’ and the staff are ‘brilliant’. They went on to say that they have tried other homes in the area, however, this ‘the best by far’.

People say they like living in the home they are well cared for, have everything they need and feel safe.

One person says the carers are very helpful and they are treated with respect and dignity at all times.

People say there are more than happy with their rooms. One person says they have everything they need and have their rooms as they want. One visiting relative says they are very happy with the services provided and their relatives’ room is always kept very clean. One person receiving day care says the home is ‘always spotless’

One visiting relative says the staff are very good and listen to what they say. People living in the home say the girls are ‘wonderful, ‘excellent’, and ‘very caring’.

One person says there is always staff around when you need them. One person receiving day care in the home says the staff are very helpful and ‘work very hard’. Another person living in the home said they can always speak to staff and they listen to what you say, they are always polite and courteous.

The inspection of Carleton Court Care Home took place on 1 December 2014 and was unannounced. We also visited for a second day on 2 December 2014; we told the registered provider at the end of our first day that we would be returning the following day.

We previously inspected the service on 27 and 30 May 2014 and, at that time we found the registered provider was not meeting the regulations relating to safeguarding people who use services from abuse, management of medicines, requirements relating to workers, assessing and monitoring the quality of service provision and records. We asked the registered provider to make improvements. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Carleton Court Care Home is registered to provide accommodation and personal care for up to 32 older people, including some people who were living with dementia. The home is over two floors and has a number of communal lounge and dining areas. There is also a garden that is accessible for people who live at the home. The home is close to Pontefract town centre.

The registered provider is also the registered manager for the service. 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 who lived at the home told us they felt safe. However, we found that people’s medicines were not managed or administered to people safely.

During our inspection we were told about an incident where someone may have been at risk of harm. The registered provider had not discussed this matter with the local authority safeguarding team.

We saw the registered provider had made improvements to their recruitment processes.

Staff told us they received regular supervision and training, however, we saw from the provider’s training matrix that not all staff training was up to date.

We saw people had a care plan in place for mental capacity, this detailed how staff should involve people in making simple lifestyle choices. Through our observation and discussion with staff we saw they were caring.

The registered provider gained the views and opinions of people who used the service. They held regular meetings and issued quality questionnaires to people annually.

People who lived at the home were not always encouraged to be involved in making simple lifestyle choices about their day to day activities.

Following our last inspection the registered provider had implemented some auditing systems. We saw they had begun to analyse people’s accidents, although they had not audited people’s care plans and the audit system for medicines had failed to identify or address the failings we had detected. You can see what action we told the provider to take at the back of the full version of the report.