Enter and view: Carlton Court Care Home

Healthwatch Barnet carried out an unannounced Enter and View visit to Carlton Court Care Home on 24 February 2016. Carlton Court, operated by the TLC Group, provides residential, nursing and dementia care and was accommodating 57 residents at the time of the visit, while undergoing a major refurbishment programme. 

Overall, Healthwatch found Carlton Court to be a well-run home with a friendly, welcoming atmosphere and caring staff. Despite disruption from ongoing building works, inspectors observed positive relationships between staff, residents and visitors, and noted that the recently appointed manager and deputy manager were well regarded by residents, relatives and staff. 

The home provided purpose-built accommodation spread across four floors, including specialist dementia and nursing units. Bedrooms were ensuite, residents were able to personalise their rooms, and dementia-friendly features had been incorporated into refurbished areas. Inspectors found the environment generally clean and uncluttered, although they noted occasional odours of urine in some areas and that parking could be difficult because of building work and local restrictions. 

Care planning arrangements were thorough. Prospective residents underwent detailed assessments before admission, with information gathered from healthcare professionals, relatives and carers. Care plans were updated monthly and included nutritional monitoring, risk assessments and information about residents’ preferences and personal histories. Relatives were generally involved in care decisions, although some were unfamiliar with formal care plan terminology. 

Residents received regular healthcare support through weekly GP visits, specialist nursing input and palliative care services when required. Weight, nutrition and hydration were monitored, and staff maintained records of food and fluid intake. However, inspectors could not fully verify some aspects of healthcare management because certain documentation and records were unavailable during the visit. 

Feedback about staff was largely positive. Residents and relatives frequently described staff as friendly, patient, caring and supportive. Inspectors observed staff interacting warmly with residents, including using reassurance, distraction techniques and personalised approaches for people living with dementia. Staff themselves described Carlton Court as a pleasant place to work and said they felt supported by management. 

A challenge identified by both staff and Healthwatch was the home's reliance on agency workers. Staff reported that agency workers often did not know residents well or understand routines, which could affect continuity of care. There had also been a turnover of approximately 25% of staff during the previous year. 

Training provision was comprehensive and included dementia care, safeguarding, moving and handling, nutrition, pressure care and clinical skills. Healthwatch observed examples of staff applying their training effectively, particularly when supporting residents with dementia-related distress and behavioural challenges. 

The activities programme was viewed as a particular strength. Residents could participate in exercise sessions, music, singing, painting, films, gardening and outings. Inspectors observed well-attended activities during the visit and saw residents responding positively to sensory and social engagement opportunities. Relatives also praised the range and quality of activities available.

Food quality was generally praised. Meals were prepared on site and residents could choose from multiple options at each meal, with specialist diets catered for where necessary. However, inspectors observed some delays at mealtimes due to staffing pressures. In some cases residents requiring assistance waited for support, causing food to cool before it was eaten. Healthwatch also felt more could be done to encourage hydration and offer a wider choice of drinks. 

While most relatives were very satisfied with the care provided, concerns were raised about communication. Some relatives felt they were not always informed promptly about room moves, decoration works or aspects of their relatives’ treatment and care. There were also concerns from some relatives about delays in changing incontinence pads, although issues were generally addressed when brought to staff attention.

Healthwatch concluded that Carlton Court provided a caring and positive environment with committed staff, strong activity provision and good-quality care. However, improvements were needed in communication, staffing consistency, mealtime support, hydration and personal care monitoring. Recommendations included reducing reliance on agency staff, improving communication with relatives and external agencies, ensuring incontinence products were changed promptly, offering a wider range of drinks and increasing staffing support at mealtimes. 

The home accepted the recommendations and reported that additional permanent staff had been recruited, communication systems had been strengthened, staff had been reminded about dignity and continence care, drink choices had been expanded, and staffing arrangements at mealtimes had been improved.