Our inspection of Carlton Nursing Home took place on 7 March 2017 and was unannounced.

At the last inspection in March 2016 the service had been in breach of the Health and Social care Act 2008 (Regulated Activities) regulations 2014 regarding the management of medicines. At this inspection we saw improvements had been made and the service was meeting the relevant requirements.

Carlton Manor provides care and support for up to 32 older people who may be living with dementia or mental illness and younger adults with a physical or learning disability. At the time of our inspection there were 25 people living at the service.

The service had a registered manager who had been in post since March 2015. 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 told us they felt well supported by the registered manager and they were approachable. This was confirmed by comments from people and their relatives.

Effective safeguarding procedures were in place. Staff were trained in safeguarding and understood how to keep people safe. Assessments were in place to mitigate risks to people and these were updated appropriately.

Accidents were documented with actions taken and outcomes including reviews and amendments of care plans and risk assessments.

Systems for managing medicines safely were in place. People received medicines appropriately from regular staff although some medicines administered by agency staff were not always given at the required time.

The service was meeting the legal requirements relating to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

The service was clean and well maintained and a range of checks was in place to ensure this. People's bedrooms were homely and personalised.

Staffing levels were sufficient to keep people safe and staff training was up to date or booked. The recruitment process ensured staff employed were suitable to work with vulnerable people and regular supervision and appraisal was in place.

A range of activities was on offer and we saw planned activities took place.

People were supported to consume a varied and nutritious diet and people's choices were respected. People told us they enjoyed the food.

Complaints were taken seriously and addressed. People and their relatives told us they knew how to complain if necessary.

Staff knew people's care and support needs and people told us staff were kind and caring. We saw people were treated with dignity and respect. There was a relaxed and welcoming atmosphere at the service.

People had access to a range of healthcare professionals.

Care records were mainly person centred and appropriate to people's needs although further work was being undertaken to improve these including further documented evidence of people's involvement in care reviews. Some people's plans of care were not always fully understood and accurately followed by staff.

Systems were in place to monitor and improve the quality of the service and people and staff were encouraged to voice their opinions through surveys, meetings and questionnaires.

This inspection took place on 5 February 2016 and was unannounced. We last inspected the service in February 2014 when we found compliance with all of the regulations inspected.

Carlton Manor provides care and support for up to 32 older people who may be living with dementia or mental illness and younger adults with a physical or learning disability.

The registered manager has been in post since March 2015.

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 told us the manager was approachable and supportive.

People living at the home told us they felt safe. Although there were systems in place to protect people from risk of harm and staff had been trained in how to keep people safe, we found that the systems for managing medicines had not always been followed as staff were not maintaining an accurate record of medicines used. This meant the provider was in breach of regulation.

We also found staff did not always maintain the principles of safe moving and handling.

Recruitment processes were robust and thorough checks were always completed before staff started work to make sure they were safe and suitable to work in the care sector. Staff told they received good levels of training and we saw documentation which evidenced this.

There were enough staff on duty to make sure people’s care needs. Activities were offered and the service had recognised through their own auditing systems that improvements could be made to this provision.

The home was well maintained and systems were in place to make sure it was safe. People’s bedrooms were personalised and we found everywhere to be clean and tidy.

We found people had access to healthcare services and healthcare professionals were involved in supporting the well-being of people living at the home.

Staff were caring and treated people with respect. The privacy and dignity of people was considered through care planning and people were respected. People told us the staff were good.

People told us they enjoyed the food and choice was available.

More could be done to support people living with dementia in their orientation around the home.

We recommend that the provider looks at additions to the call system so that people can have call bells within their reach at all times.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

Systems were in place to seek the views of people who lived at the home and their families and to monitor the quality of the service provided.

We found one breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.’

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still the registered manager on our register at the time of the inspection. A new home manager has been appointed but was unavailable on the day of the inspection.

In the absence of the home manager information contained in this report was provided by the group operational manager and group governance lead employed by the organisation who were present at the home on the day on inspection.

People who were able told us they enjoyed living at Carlton Manor and were complimentary about the care provided by staff. One person said "I have lived here a number of years; I am well looked after and have no concerns”. Another person said "I like living here; I know the staff and have made some friends."

We spoke with two visitors and they told us they were pleased with the standard of care and facilities provided by the service. One person told us they were happy their relative was well cared for and were always made to feel welcome when they visited.

We found the nursing and care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

During the visit we had the opportunity to speak with three people who used the service and one relative. Everyone told us they were "very happy" with the care and support provided at Carlton Manor. They said the staff were "wonderful", "very approachable" and professional and caring.People told us they could make choices and decisions about how they wanted to spend time at the home and staff encouraged them to be fully involved making decisions about their care and treatment.

A relative told us they were involved in discussions/decisions about their relatives care needs and were kept informed about any changes. They said "the staff are great I don't think there is anything my relative needs, my relative is well looked after here." People who lived in the home and their relatives said the food was very good and the home was clean, warm and comfortable.

People who were able told us that they could make choices and decisions about how they wanted to spend time at the home and staff encourage them to be fully involved in their care and treatment. They also told us that they were pleased with the standard of care and support provided and that staff were professional and caring.