Drayton Court

Drayton Court is a residential care home providing accommodation and personal care to up to 45 people. The service provides support to older people and people with dementia. At the time of our inspection there were 44 people using the service. Care is provided over three floors. Each floor has different themed décor with communal lounges, dining areas and a kitchenette.

People’s experience of using this service and what we found

Improvements continued to be needed within the provider’s governance systems to ensure people received high quality care. Although the provider had systems and processes to check the safety and quality of the service, oversight of some risks to people’s health and wellbeing was not always effective.

We found no evidence people had been harmed but some risks to people's health had not always been assessed or monitored. Where risks were identified, records were not always accurately updated to reflect changes.

Records did not provide assurance people received their medicines as prescribed. Where discrepancies in stock levels were identified, it was not always clear what action was taken to investigate the errors or ensure the person’s health was not adversely affected. Some people had medicines that could be given when required to reduce short term conditions such as anxiety or pain. Records were either not in place or did not contain enough information to support staff to know at what point to administer these medicines.

There were enough staff to keep people safe. However, there were particular times of day where staff could not provide timely, high quality care. The recruitment process continued to ensure staff were suitable for their roles by conducting relevant pre-employment checks.

People told us they felt protected from the risk of abuse and staff understood their safeguarding responsibilities. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The home was clean, and staff followed good infection control processes. The home was facilitating visiting in line with government guidance.

A new manager had been recently employed and was committed to driving forward improvements at the home. People and staff spoke positively about the new manager. The provider recognised the importance of being open and honest when things went wrong. Learning from incidents was used to educate staff to prevent reoccurrence.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 July 2019) and there was a breach of the regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about risk management. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Drayton Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan and meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Drayton Court is a care home, providing personal care and accommodation for up to 45 people. It provides care to older frail people, some of whom are living with dementia. The care home also offers ‘day-care’ on specific days of the week, the day care lounge is separately staffed. Care is provided over three floors. Each floor has communal lounges, dining areas and a kitchenette. At the time of our inspection visit 37 people lived at the home.

What life is like for people using this service:

Risks were not consistently well managed because actions to mitigate some identified risks had not been taken. Risk management plans did not always give staff clear guidance on how they should support people. There were sufficient staff on duty during the day shift. A few staff felt night time staffing was too low and the new manager told us they would look at this.

People had their prescribed medicines available to them and were supported with these by trained staff. Staff did not consistently ensure people’s medicines or prescribed items were stored securely which posed risks to people.

Staff received an induction, training and support from within the staff team, the provider’s trainer and managers. Despite staff being told about the provider’s values and vision, this was not embedded into the culture of the home as staff could not tell us what this was. Overall, the home was clean and tidy, and staff understood how to prevent risks of cross infection. There were some bedrooms with an offensive odour.

People had their needs assessed before they moved into the home. Overall, people had plans of care relevant to their needs. However, plans of care around pain management or future wishes for end of life care had not always been completed. Staff were trained to meet people’s day to day needs and protect people from the risks of abuse.

We received mixed feedback from people about what it was like to live at the home. Those people who required less staff support experienced more positive outcomes. People had opportunities to engage in group activities, however, these largely took place in the day care lounge and meant people who chose to remain on their 'household' or in their bedroom were at risk of social isolation because there were limited opportunities to engage in activities or with staff.

People had access to healthcare when required. People were offered enough food and drink to meet their dietary requirements. However, people’s mealtime experience was not always relaxed or enjoyable.

Some positive caring interactions took place between people and staff. However, some staff failed to follow the provider’s policies which posed potential risks to people and did not consistently reflect a caring attitude.

People made day to day decisions about their care and were supported by staff who worked within the principles of the Mental Capacity Act 2005.

Staff did not consistently ensure people’s private care records were stored securely or confidentially.

Overall, the provider’s quality assurance system identified where improvements were needed, but this was inconsistent and did not always ensure quality and safety.

A new manager had started and was prioritising areas that required improvement.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 12 Regulated Activities Regulations 2014 – Safe care and treatment

Rating at last inspection: The service was rated outstanding. (The last report was published on 18 April 2016).

Why we inspected: This was a planned inspection based on the rating of the last inspection. The service is now rated as ‘Requires Improvement’ overall.

Enforcement: Action provider needs to take (refer to end of report).

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

There was a registered manager in post. 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.

The service provides accommodation and personal care for up to 45 older people, who may have dementia. Forty-four people were living at the home at the time of our inspection.

People were at the heart of the service. The provider’s philosophy, vision and values were understood and shared across the staff team. People were supported to maintain their purpose and pleasure in life. People’s right to lead a fulfilling life was enshrined in a charter of rights, which was displayed in the entrance to the home.

People and relatives were delighted with the care and support provided by the staff, which exceeded their expectations. Staff took time to understand people’s life stories and supported and encouraged people to celebrate important personal and national events. People were supported to retain an active presence in the local community and to maintain their personal interests and hobbies.

The provider employed a team of exercise and activity co-ordinators who were dedicated to supporting people to make the most of each day. The group activity sessions were effective and the positive impact on people’s moods was visible; people continued to smile and sing after an exercise session ended.

People planned their own care, with the support of their relatives and staff, to ensure their care plans matched their individual needs, abilities and preferences, from their personal perspective. Care staff showed insight and understanding in caring for people, because they understood people’s individual motivations and responses.

People who lived at the home, their relatives and other health professionals were encouraged to share their opinions in a format that was appropriate to their needs, to make sure their views drove planned improvements. The provider had researched and reflected on how international exemplar services provided care and planned to refurbish the home in accordance with current best practice principles.

The provider was innovative and creative and constantly strived to improve the quality of people’s lives, by working in partnership with experts in the field of dementia care. Planned improvements were focused on improving people’s quality of life.

All the staff were involved in monitoring the quality of the service, which included regular checks of people’s care plans, medicines administration and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence. The provider shared their learning with all the homes in the group.

The home was divided into three ‘households’, each with their own lounges and dining rooms. Each household was individually supported by a care co-ordinator and three care staff. Care co-ordinators were part of the duty management system, which meant there was a named manager available to respond to issues and to support staff, seven days a week.

There were enough staff on duty to meet people’s physical and social needs. The registered manager checked staff’s suitability to deliver personal care during the recruitment process. The premises and equipment were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.

Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns. Staff understood the risks to people’s individual health and wellbeing and they were clearly recorded in their care plans.

Staff were attentive to people’s appetites, moods and behaviours and were proactive in implementing individual strategies to minimise people’s anxiety. Staff were proactive in ensuring people obtained advice and support from other health professionals to minimise the risks of poor health.

Staff received training that matched people’s needs effectively. Staff received training in the provider’s values and philosophy, which included, ‘play, make their day, be there and choose your attitude’. The management team exemplified the philosophy in their interactions with people, which set the standard for staff to follow. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having capacity, records showed that their advocates or families and other health professionals were involved in making decisions in their best interests.

Risks to people’s nutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs and people knew staff would support them to maintain a balanced diet.

Care and treatment was planned in a way that ensured people's safety and welfare. One person said 'There are some complex needs required here and they care for them in a way that keeps them safe.'

All staff are subjected to appropriate checks and references were taken up prior to commencement of employment. All staff were trained to be able to deliver the care and support required by individuals. One person said 'All the staff are knowledgable and well trained.'

We spoke to the home manager, the care manager, people who use services their relatives and staff. Comments we received were all positive and included 'I love it here.' and 'It's like home from home.'

Staff members we spoke with told us that they were happy working at Drayton Court, that the managers were supportive and they felt valued and listened to.

Staff spoken to had a good awareness of individuals care needs and the importance of treating people with respect and dignity. This was confirmed by the training provided around respect and dignity and by talking to people who use the services. Comments included 'We are all happy here together, I feel safe.' and 'It is absolutely marvellous here, they look after me and they keep my room spotless.'

People who used the service told us they were happy with the way staff provided their care. One person told us, 'They look after me and know how I like things done. They are all friendly.'

We asked relatives about the care provided to their family and they each told us that the care delivered to people was good. One relative told us, 'My mother is always smart and enjoys the meals here.' Another relative told us, 'Staff are very good but very busy.'

We saw people's bedrooms were clean, warm and well furnished. People had brought some personal items with them into the care home and this made their rooms "homely".

We saw that mealtimes were a relaxed and social occasion and that people had a choice about what they wanted to eat and drink.

Staff told us they had regular training, which meant they could support the specific needs of people who used the service. Records we looked at showed that staff communicated people's changed needs to managers so that care needs could be re-assessed promptly.