Royal Mencap Society - Drummond Court Also known as Drummond Court

We were not assured that the provider was promoting safety through the layout and hygiene practices of the premises. However, the provider informed us of action they would take to immediately rectify this.

There was a lack of signage and instructions to explain for visitors what people should do to ensure safety and prevent the risk of cross infection.

We found the following examples of good practice.

The service was accessing the government testing scheme which assisted them to promptly identify an outbreak. The service worked with the local authority infection, prevention and control (IPC) team and other health professionals in managing the outbreak.

There was a plentiful supply of personal protective equipment (PPE).

Staff helped people to maintain links with their family and friends by phone and on-line.

Further information is in the detailed findings below.

This unannounced inspection took place on 14 and 15 November 2017.

There were two registered managers in post when we inspected the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 brought forward this inspection due to concerns of which we had become aware that had been reported to the local authority safeguarding service. These concerns included a person not having an appropriate lunch prepared for them when away from the service for the day, people having ill- fitting or were wearing other people’s clothes and looking unkempt and a two-way communication book used by Drummond Court staff and another service not being completed or sent with the person when attending another service. We spoke with the local authority safeguarding team and learnt that these concerns had not been substantiated by them and had been closed.

The overall rating of this service was Requires Improvement at our last inspection of 23 and 26 May 2016. The key questions Safe and Effective were rated as Requires Improvement. Care, Responsive and Well-led were rated as Good.

At this inspection we found the service had improved and is now rated ‘Good’ overall. There had been improvements made in the service. This included much clearer and robust moving and handling risk assessments being in place and staff knowing how to support people with regard to their moving and handling needs. Monitoring of medicine stocks had been increased and staff were knowledgeable about people’s medicines and why they had been prescribed. Staff were aware of people’s assessed needs including those people requiring support to manage their diabetes.

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.” Registering the Right Support CQC policy

The staff demonstrated a clear understanding of the actions they would take if they suspected or witnessed any concerns about people’s safety. Risks were assessed and management plans were in place to minimise the risk to people’s safety while respecting their right to pursue interests of their choice. Medicines were managed safely and sufficient numbers of trained staff were deployed to meet people’s needs.

Staff had received infection control training and used this information for the storage of food and cleanliness of the accommodation.

The registered managers learned from incidents or accidents within the service and made the necessary improvements. They shared this information with the staff through supervision and staff meetings.

Staff were provided with a wide range of training appropriate to the various needs of the people living at the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were provided with a healthy and well balanced diet and were encouraged to take part in the preparation of meals.

Other professionals worked with staff so that people had access to healthcare services and on-going healthcare support.

People were involved in the running of the service. They had been asked to give their views about the decoration of the premises and design of the garden area which had been implemented in line with their wishes.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the polices and systems in the practice support this practice.

People were treated with kindness and compassion. It was evident that positive relationships had developed between people and care staff. People expressed their views to staff about the support they required and their dignity and privacy were respected.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were clearly documented. People were supported to raise concerns.

Good leadership was in place. Staff spoke positively about the registered managers and the support they received. Staff viewed that the registered managers were approachable and would listen to suggestions made in how to improve the quality of care provided. Regular reviews of the quality of care were carried out and the service worked in partnership with other agencies for the benefit of the people living there.

Further information is in the detailed findings below.

The service provides care and support for up to 36 people who have learning disabilities and/or autistic spectrum disorder. At the time of our inspection there were 32 people using the service.

The service did not have a registered manager in place but an application had been made and was awaiting consideration by the 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.

Staff were trained in safeguarding people from abuse and systems were in place to protect people from abuse. Staff understood their responsibilities to report any safeguarding concerns they may have and were confident they had the skills to do this.

Risks to people and staff were assessed and action taken to minimise these risks. People were encouraged to remain as independent as possible and any specific risks related to this were assessed. However we observed one person to be at risk with regard to their moving and handling and the service had not taken a proactive approach to this.

Medicines management had improved considerably since our last inspection and was mostly good. We did, however, find some stocktaking discrepancies and one pain relieving medicine which had been dispensed but did not appear in the records. Therefore medicines could be more safely managed. We have made a recommendation about this aspect of medicines management.

Staffing levels meant that people were safe and increased staffing had already had a beneficial impact on people’s ability to go out. Recruitment procedures were designed to ensure that staff were suitable for this type of work and checks were carried out before people started work to make sure they were safe to work in this setting. New staff were able to shadow more experienced staff and a robust induction was provided.

Training was provided for staff to help them carry out their roles and increase their knowledge of the healthcare conditions of the people they were supporting and caring for. Staff were supported by the managers through supervision and appraisal systems.

People gave their consent before care and treatment was provided. Staff had been provided with training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. People’s capacity to give consent had been assessed and decisions had been taken in line with their best interests. There was a good understanding of processes related to DoLS.

People were supported with their eating and drinking needs and people were fully involved in shopping and cooking. Staff helped people to maintain good health by supporting them with their day to day physical and mental healthcare needs, although support plans for people with diabetes were not clear and staff were confused about their responsibilities.

Staff were caring and treated people respectfully making sure their dignity was maintained. Staff were positive about the job they did and enjoyed the relationships they had built with the people they were supporting and caring for. The atmosphere was of a positive and friendly service.

People, and their relatives, were involved in planning and reviewing their care and were encouraged to provide feedback on the service. Care was individualised and subject to on-going review and care plans identified people’s particular preferences and choices. People were supported to follow their own interests and hobbies and to have meaningful occupation whilst at Drummond Court.

Formal complaints were well managed and had been investigated and resolved satisfactorily. Relatives were invited to discuss any concerns they had and the regional operations manager was open and honest about one poor response which had been given to a relative raising a concern.

Staff understood their roles and were well supported by the management of the service. The service had an open culture and people felt comfortable giving feedback and helping to direct the way the service was run. Staff were positive about their work and the regional operations manager had worked hard to create a positive and inclusive staff team.

Quality assurance systems were in place and audits were carried out regularly to monitor the delivery of the service. Improvements were evident and the regional operations manager and prospective registered manager had clear ideas as to the priorities for the service. There was a clear management plan in place until March 2017.

Although the overall rating for this service is Requires Improvement it is important to recognise what a progression this represents. Our previous inspection rated this service as Inadequate and placed it into Special Measures. The rating of this inspection identifies that there are still some issues which need addressing before the service is operating as a good service overall. However, parts of the service are operating at a good level and the improvements in all areas were evident. There was also a clear change in atmosphere and those people who used the service and staff were more relaxed, had purpose and occupation and were positive about the future. Some relatives remain concerned and it will take time for the service to earn their trust. The task will now be to continue with the improvements which are underway and to sustain the good practice that we found.

In addition to placing the service in ‘special measures’ we also served warning notices as the service was in breach of regulations 13 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The regulation 13 warning notice was issued because the service had failed to protect people from the risk of financial abuse and staff had not responded appropriately to a possible safeguarding issue. These issues had also been identified at the previous inspection which was carried out on 10 December 2014. This meant that the service had not made the required improvements over a sustained period of time. The regulation 18 warning notice was issued because the service failed to ensure there were enough suitably qualified, competent, skilled and experienced staff on duty and had failed to provide them with the training and support they needed. The warning notices required the service to make the necessary improvements by 15 December 2015.

We undertook this focused inspection on 14 January 2016 to ensure that the service had made the required improvements. The inspection was unannounced. This report only covers our findings in relation to safeguarding and staffing issues and does not affect the overall rating of the service which remains Inadequate. The service will remain in special measures until we carry out our next comprehensive inspection. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Royal Mencap Society Drummond Court on our website at www.cqc.org.uk.

Drummond Court provides care and support for people with learning disabilities who live in bungalows and flats on the same site. Some people are quite independent while others have significant care needs and require more support and care. The service is registered to provide care for 36 people and at the time of our inspection 33 people were resident.

The service had no registered manager in place. The most recent registered manager had left the service in February 2015 and the manager appointed to replace them had also left the service without becoming registered. 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.

This report specifically focuses on the key area of Safe with regard to how staffing and safeguarding matters were managed.

Staff reported that there was now a more consistent staffing pattern. Some temporarily deployed staff now had substantive posts and the service had recruited new staff. The regional manager, who had been redeployed to support the service, was also to continue to have line management responsibility for the service which provided further continuity. The vacant hours had reduced and those that remained were mostly being covered by regular agency staff who knew people well.

Staff told us they felt more supported and most staff were receiving regular supervision, although some concerns remained in one area of the service. Staff appreciated the fact that they were less likely to be asked to cover shifts in parts of the service they were not familiar with. New staff had been given a structured induction and had been supported throughout. There was a recruitment procedure in place but it was not followed in one instance.

Rotas showed that some areas of the service continued to operate with staffing levels which made it difficult for people with high care and support needs to access their local community and follow their own interests and hobbies. The service was waiting to see if increased funding could be secured to assist with this on-going issue. Staff had been redeployed to mitigate the low staffing levels, however service managers remained office based.

Staff had received training in keeping people safe from abuse and knew how to identify the possible signs of abuse and take action. Systems were in place to protect people from financial abuse and staff were working in accordance with them.

Staff demonstrated a good understanding of how to manage incidents where people became distressed and behaved in a way which may have placed others at risk. There were processes in place designed to keep people safe from physical harm. Incidents of physical harm caused in this way had reduced but all risks had not been mitigated and the service continued to notify us and the local authority safeguarding team of new incidents.

Overall, although there was clearly still some work to do, we found that the service had made sufficient progress to meet the requirements of regulations 13 and 18.

This is the summary of what we found:

Is the service safe?

Care records were generally updated to ensure that people received the care they needed to keep them safe. We did find some records which were not completed appropriately and contained conflicting information which could have put some people at risk.

The service worked with other healthcare professionals to help meet people's healthcare needs.

We saw that regular checks were carried out on equipment and systems, such as the fire alarm system, to make sure they were safe to use. We were concerned that advice given at the last two fire system checks had not been followed up and we have referred our concerns to the fire service.

We looked at staffing rotas and found that there were enough trained and experienced staff on duty to meet people's needs and ensure their safety. We saw that new staff and agency staff had received an induction to ensure they were informed about how to meet the needs of the people who used the service and keep them safe.

We found that the service was fully aware of their responsibilities under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and that staff had received training. We saw that the service was considering making a DoLS application for one person.

Is the service effective?

People's care and support needs were assessed in consultation with either the person themselves or their relative. People's care plans reflected their care and support needs and the service worked with external healthcare professionals to meet them.

We were concerned that some people's plans contained conflicting information which might have made it difficult for staff to support them effectively and safely.

People who used the service told us that they were happy and we observed that most people attended a variety of activities and were involved in their local community if they chose to be.

We were concerned that some people who needed a higher level of support did not have sufficient opportunities for meaningful activity both at the service and in the community. One relative of a person who used the service was very concerned about the lack of activity and occupation provided.

We saw that people were supported to increase their independent living skills and some people were planning to live more independently in the future.

Is the service caring?

People were supported by staff who were kind, caring and respectful. We observed staff engaging positively with people and encouraging them to increase their independent living skills.

People who used the service told us they were happy with the care provided and spoke positively about the staff. One relative of a person who used the service told us, 'The staff are on the ball. I have no worries there. Whenever I come [my relative] is lovely and clean and well looked after'.

Is the service responsive?

People's care records showed that where concerns about an individual's wellbeing had been identified, staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance promptly from other health care professionals when one person's health had declined recently.

Protocols and care plans had been put in place to support one person whose behaviour could be challenging to staff and other people who used the service. The service had secured additional funding to pay for one to one staffing for this person.

People's preferences and choices had been recorded in their care plans and we observed that generally care and support was delivered in accordance with people's wishes.

We were concerned that people living in one particular bungalow were not always given the opportunity to make choices about how they spent their time.

Is the service well led?

We saw that considerable improvements had been made by the registered manager since the last inspection. The service had a quality assurance system in place but the issues we identified, which related to some poor record keeping and lack of meaningful activity for some people, has not been identified.

We saw that staff received the training they needed to carry out their roles and that they were supervised and supported by the manager.

The service sought the views of the people who lived there as well as those of relatives, other professionals and staff. Issues raised as a result of surveys sent out to people were put into an action plan to make sure improvements were put in place.

During our inspection we spoke with seven people who used the service. People we spoke with had limited communication skills but were able to demonstrate that overall they were satisfied with the support they received. One person told us, 'Things are getting better.' Another told us, 'Staff are very good to me. I like it here.' However, people also told us they were not being consulted and communicated with regarding changes to the day services provided on site and the decision made to charge people for transport services.

We saw that people were protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines.

We looked at the care records in detail of four people where recent safeguarding concerns had been received by the Care Quality Commission (CQC). We were satisfied that appropriate actions had been taken to investigate and manage the concerns.

We looked at the care records in total of seven people who used the service. We saw that further work was needed to ensure that records were regularly updated to reflect the current needs of people who used the service.

We found that some people were supported to take part in a wide range of activities. However people with more complex needs did not benefit from as much interaction and stimulation. A recent staffing re-organisation meant that significant numbers of staff were leaving the service. This posed a risk to continuity of service because a full complement of replacement staff had not yet been recruited. Some feedback had been sought from relatives and residents, but there was scope to seek out the views of other healthcare professionals and to ensure that all feedback is acted upon in order to make service improvements. Internal audit work had taken place but some action was still outstanding.