Archived: 51 The Drive

51 The Drive is residential care home providing care for to up to 3 people with a diagnosis of learning disabilities, autistic spectrum disorder or mental health needs. At the time of the inspection 2 people were living in the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Right Support:

Risks to people had not always been assessed or mitigated. Risk assessments did not always contain the strategies required to reduce the known risks to people.

Medicine management required improvement. Records were not always kept up to date and staff told us that unsafe medicine practices had occurred.

People’s care plans and risk assessments were not always kept up to date. We found incorrect information recorded and some areas were missing.

People were not always supported to have maximum choice and control of their lives and we could not be assured that staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care:

The provider had not completed any investigation when people were found with unexplained injuries. Safeguarding procedures had not been consistently followed as unexplained injuries had not always been reported to the local safeguarding team.

Staff did not always have the information required to support people safely and, in a person-centred way. Issues with accessing the electronic care planning system meant at times staff had no access to people’s care plans and risk assessments.

Staff did not always have sufficient training to meet people’s individual needs.

People did not always know the staff, due to high levels of agency staff being deployed. Staff were safely recruited.

Infection prevention and control procedures needed to be followed to protect people from the risks of infection. Cleaning schedules were not consistently recorded as completed.

Right Culture:

Systems and processes were not effective in assessing, monitoring and reducing risks. Where improvements were needed these had not always been identified, due to audits either not being completed or not identifying the issues we found on inspection.

Staff did not consistently feel supported within the workplace.

Information was shared with relevant professionals and significant people. Feedback was sought from people who used the service and their relatives. Feedback was in the process of being reviewed.

The provider was open to feedback and put actions in place to mitigate concerns found on inspection.

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 6 October 2021) and there were breaches of 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 improvements had not been made and the provider still in breach of regulations.

Why we inspected

We received concerns in relation to infection control and risk management. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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 not changed from requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 51 The Drive on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safeguarding, risk management and oversight at this inspection.

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.

Follow up

We will 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.

51 The Drive is a small residential home providing personal care, rehabilitation, therapy and support for up to three people with acquired brain injuries. At the time of inspection, three people were living in the home.

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

Systems and processes to ensure people were protected from harm were not always effective. Unexplained injuries had not always been properly recorded, reported, investigated or monitored.

Systems and processes in relation to health and safety oversight needed strengthening. Some environmental risks were not mitigated. We found window openings were not consistently restricted and a large freestanding wardrobe was not secured to the wall.

People had their needs assessed prior to moving into the service, the service had developed comprehensive person-centred care plans and risk assessments. People were supported to regularly access support from the provider’s transdisciplinary team of professionals and relatives told us they were kept updated with people's health and wellbeing needs.

Staff promoted people's independence. People and their relatives where appropriate were involved in care planning and care was regularly reviewed and adjusted to support people to meet their identified goals.

People were supported to take part in activities that interested them and to maintain relationships with people who were important to them.

The registered manager gathered feedback and sought views on the quality of the service. The feedback people had provided was recognised and actioned.

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.

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

Rating at last inspection

The last rating for this service was good (published 17 July 2019)

Why we inspected

This was a planned inspection based on the previous rating.

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.

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.

We have identified breaches in relation to safeguarding, the premises and 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 for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

51 The Drive is a small residential home providing personal care, rehabilitation, therapy and support for up to three people with acquired brain injuries. At the time of inspection, two people were living in the home.

People continued to be cared for safely and with compassion. Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs. Medicines systems were well organised, and staff managed people’s medicines safely. One aspect of environmental safety required strengthening. We discussed this with the registered manager and support services manager and swift action was taken to address the shortfall in the area we identified.

Staff had access to the support, supervision and training they required to work effectively in their roles. Staff supported people to have a healthy balanced diet. People’s support was overseen by a wide variety of specialist health and social care professionals. People had prompt access to healthcare support when needed.

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.

Staff were caring, person centred and inclusive. People were treated with kindness, dignity and respect and staff spent time getting to know them and their specific needs and wishes.

People had personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. Staff encouraged people to follow their interests and people were supported to access many varied activities and interests.

Information was provided to people in an accessible format to enable them to make decisions about their care and support. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

The service had a positive ethos and an open culture. The registered manager was approachable, understood the needs of people, and listened to staff. People that used the service and their relatives had the opportunity to feedback on the quality of the support and care that was provided. Any required improvements were undertaken in response to people's suggestions. There were effective systems in place to monitor the quality of the service and drive improvements.

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

Rating at last inspection

The last rating for this service was good (published 12 November 2016).

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was not 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. A manager had been appointed however at the time of the inspection they were in the process of submitting an application to the Commission.

People felt safe in the home. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required to keep them safe and recruitment procedures protected people from receiving unsafe care from care staff unsuited to the job. People had risk assessments in place which identified and managed people’s known risks, and appropriate arrangements were in place to manage and store people’s medicines.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People had their healthcare needs managed in a way that was appropriate for each person and people’s nutritional needs were supported and managed with each person.

People received support from staff that treated them well and prioritised their needs. People were relaxed and comfortable around staff and staff understood the need to respect people’s confidentiality. People were supported to maintain good relationships with people that were important to them and the home had good links with advocacy services to ensure people had the support they required.

Care plans were written in a person centred manner and focussed on empowering people. People were encouraged to make their own personal choices and to be in control of their own lives. Care plans detailed how people wished to be supported and people were fully involved in making decisions about their care. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People at the home reacted positively to the manager and the culture within the home focussed upon supporting people to be independent. Systems were in place for the home to receive and act on feedback and policies and procedures were available which reflected the care provided at the home.

The provider sent us an action plan which set out a schedule of when work was to be carried out to improve the premises. In addition we saw copies of quotations, purchase orders and invoices. We spoke with the registered manager of 51 The Drive, who confirmed that all the improvements required to the premises had been completed as scheduled.

We found that robust staff recruitment procedures were in place and staff had regular opportunities to discuss the needs of the service and review their work performance during regular supervision and annual appraisal meetings with their line manager.

We observed that people using the service appeared relaxed and comfortable with staff. We saw that people were fully involved in setting up their care plans and encouraged to make their own decisions about their lives. We also saw that regular meetings were held with people using the service, to provide the opportunity for people to share their ideas and opinions about the service provision.

We found that some areas throughout the premises were not adequately maintained. We brought the areas of concern to the attention of the provider during our visit.