This inspection took place on 4 January 2019 and was unannounced.

Carlton Specialist Care Centre 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 Specialist Care Centre provides care and support for up to 10 people with autism and learning disabilities in one large building. Bedrooms are arranged around communal areas on the ground floor. The care service has been developed and designed in line with 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 can live as ordinary a life as any citizen.

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 2008 and associated Regulations about how the service is run.

At the last inspection, the service was rated good. At this inspection we found the rating remained good and the service met all relevant fundamental standards.

Staff understood how to keep people safe and were aware of the process to follow if they had any concerns. Risks had been assessed and recorded to ensure people were protected from harm without overly restricting people’s freedom. Positive risk assessments were in place to enable people to gain new skills in a safe and measured way.

Accidents and incidents were recorded and analysed. These were analysed by the provider’s health and safety team to ensure any lessons learnt were shared across all the provider’s locations.

Every person living at the home had a Deprivation of Liberty Safeguard authorisation in place which meant they had some restrictions in place to protect them from harm. However, where it was possible, 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.

Staff received ongoing support from the management team through a programme of supervisions and appraisals and they had been trained to ensure they had the knowledge and skills to care for people. This included specialist training to meet the specific needs of the people at the service.

People were at the heart of the service and staff were keen to ensure they respected people’s rights to privacy, dignity and maximised their independence.

There was clear evidence of person-centred care. People were involved in activities based upon their established routines and preferences. Care records contained information on how to support people and were very detailed. Reviews of people’s care needs took place at a regular interval or when their needs changed, and relatives told us how good the service was at keeping them involved and informed about their relation’s care.

Systems and processes for ensuring the quality of the service were in place. A number of audits were undertaken to ensure the provider could monitor the quality of the service they provided. These ensured the service continued to improve against nationally recognised evidence-based standards of care for people living with autism and/or a learning disability.

Further information is in the detailed findings.

This was an unannounced inspection carried out on the 10 March 2016. The service was last inspected on 6 March 2014 and we found the provider met the all regulations we looked at.

Carlton Specialist Care Centre is part of Carlton Nursing Homes Limited and provides care and support for up to 10 people with learning disabilities. The centre was registered in October 2010. On the day of our visit there were nine people 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 2008 and associated Regulations about how the service is run.

Not all of the people spoken with during the inspection were able, due to complex care needs, to tell us about their experience of living at the home. People we spoke with told us they felt safe at the home. There were effective systems in place to ensure people’s safety and manage risks to people living at the home, whilst also encouraging and promoting their independence. Staff could describe the procedures in place to safeguard people from abuse and unnecessary harm. Recruitment practices were robust and thorough.

The service had utilised guidance in relation to providing an autism friendly environment for people who use the service. This work was to be reviewed annually by the local NHS trust.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. Staff were trained in medicines management.

People were cared for by sufficient numbers of suitably trained staff. We saw staff received the training and support required to meet people’s needs well. Staff spoke highly of their training and said this prepared them well for their role.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs and preferences. People had detailed, individualised care plans in place which described all aspects of their support needs.

Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions to enhance their capacity and where people did not have the capacity, decisions had to be in their best interests.

Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. Suitable arrangements were in place and people were supported and provided with a choice of suitable healthy food and drink ensuring their nutritional needs were met.

People participated in a range of activities both in the home and in the community and received the support they needed to help them stay in contact with family and friends. People were able to choose where they spent their time and what they did.

Staff had good relationships with the people living at the home. Staff were aware of how to support people to raise concerns and complaints. The complaints procedure was also available in a pictorial format. We saw the provider had not received any complaints in the last 12 months.

There were effective systems in place to monitor and improve the quality of the service provided.

When we inspected the service in August 2013 we found people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We said that improvements were needed and judged the area of non-compliance had a minor impact on people who used the service. We returned on this visit to check whether improvements had been made.

On the day of our visit, we spoke with the team leader on duty and the Group Operational Director. Due to the focussed nature of this inspection we did not, on this occasion, speak with people who lived at the home or their relatives.

During this visit we looked at the temperature records for the treatment room. We found the recorded temperature throughout February 2014 meant medicines were being stored safely.

The team leader on duty told us they had changed how topical applications were recorded.

We saw the Controlled Drugs (CD) Register contained the name of the medication.

Staff had undergone a medication competency assessment and had received training in medication administration.

Due to their complex care needs we were unable to speak to people who lived at the home. In order to gain an understanding about people's experiences, we observed care, read care records and spoke to staff.

During our visit we looked at the care records of three people who lived at the centre. We saw evidence that people and their relatives were involved in making choices; decisions regarding their care and people's views and opinions were recorded.

We observed positive interactions between care workers and people using the service and staff used a range of verbal, non-verbal and signing communication techniques to communicate with people.

Staff told us that they enjoyed working at the home one told us "I love my job."

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs and were unable to tell us their experiences directly.

We had the opportunity to observe staff speaking and interacting with people who use the service using a range of verbal, non-verbal and signing communication techniques. We participated in discussions with two people who use the service about their daily care and how they wished to spend their day. We also looked at people’s care records and activity plans.

Many of the people who use this service could not tell us directly about their experiences due to a variety of complex needs however, staff observed had good relationships with these people and they were seen to have their privacy and dignity respected.

Many of the people who use this service could not tell us directly about their care due to a variety of complex needs.

Many of the people who use this service could not tell us directly about their care due to a variety of complex needs. However, from observations made at the site visit, looking at records and information from people who use the service’s representatives people are happy with the service they receive and how their needs are met.