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, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.