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Inspection carried out on 24 October 2017

During a routine inspection

This inspection took place on 24 October 2017 and was unannounced. The Drive is a ‘care home’. People in care homes receive accommodation and nursing, or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Drive accommodates up to 12 people with learning and physical disabilities in one adapted building. At the time of our inspection there were 11 people living at the home.

The home had a registered manager in place. 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.

At our last comprehensive inspection of the service in September 2016 we found a breach of regulations because medicines were not safely managed. We also found improvement was required to ensure the service complied fully with the requirements of the Mental Capacity Act 2005 (MCA), and the provider’s quality assurance systems were not consistently effective in identifying issues or driving improvements.

Following the inspection the provider wrote to us to tell us the action they had taken to address the issues we had identified in respect of medicines management. We conducted a focused inspection of the service in February 2017 to check that they had followed their action plan and found that medicines were safely managed at the service, and they were meeting legal requirements.

At this inspection we found the registered manager and provider had made improvements to the service’s quality assurance systems, and action had been taken to address any issues identified through the checks and audits conducted by staff. Improvements had also been made to ensure staff followed the requirements of the MCA where people lacked capacity to make decisions for themselves.

Risks to people had been assessed and plans put in place to manage identified risks safely. Staff were aware of people’s risk assessments and the action to take to support them in safely. There were sufficient staff deployed at the service to meet people’s needs and the provider followed safe recruitment practices when employing new staff.

Medicines were stored securely, and administered and recorded appropriately. People were protected from the risk of abuse because staff were aware of the types of abuse and knew the action to take if they suspected abuse had occurred. The provider had also sought to ensure people were only deprived of their liberty in line with the requirements of the Deprivation of Liberty Safeguards (DoLS), where this was in their best interests.

Staff received an induction when they started work at the service and were supported in their roles through regular supervision and training. People were supported to maintain a balanced diet and to access a range of healthcare services when needed. Staff treated people with dignity and respected their privacy. People told us that staff treated them kindly and we observed caring interactions between staff and the people living at the service.

People were involved in decisions about their care and treatment. They had support plans in place which had been developed based on an assessment of their individual needs and which reflected their preferences. Where appropriate, relatives told us they had been consulted in the development of people’s support plans. People were also supported to take part in a range of activities in support of their interests.

The provider had a complaints policy and procedure in place which gave guidance to people on how to raise concerns. People and relatives knew how to make a complaint and expressed confidence that any issues they raised would be addressed.

People spoke positively about the registered manager and t

Inspection carried out on 27 February 2017

During an inspection to make sure that the improvements required had been made

This inspection took place on 27 February 2017 and was unannounced. The Drive is a care home which provides accommodation and support for up to twelve people with learning and physical disabilities. There were nine people using the service at the time of our inspection.

We carried out an unannounced comprehensive inspection of this service 27 September 2016 at which a breach of a legal requirement was found. We found that people’s medicines were not being managed safely. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the management of medicines at the home.

The home did not have 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 current manager had begun the process of applying to the CQC to become the registered manager for the home.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Drive’ on our website at www.cqc.org.uk.

We found that the provider had addressed the breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities Regulations 2014). There were safe systems in place for storing, administering and monitoring medicines at the home. We found that medicines were managed appropriately and people were receiving their medicines as prescribed by health care professionals.

We could not improve the rating for ‘safe’ from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Inspection carried out on 27 September 2016

During a routine inspection

This inspection took place on 27 September 2016 and was unannounced. The Drive is a care home which provides accommodation and support for up to twelve people with learning and physical disabilities. There were nine people using the service at the time of our inspection.

At the time of our inspection, there was no registered manager in place. 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 previous registered manager had stopped working for the service in April 2016. The current manager confirmed they were in the process of applying to become registered.

At our previous inspection on 09 October 2015 we found a breach of regulations because risks to the health and safety of people were not always properly assessed. We asked the provider to take action to make improvements in this area, and this action had been completed.

At this inspection we found a breach of regulations because people’s medicines were not managed safely. One person’s medicines had been incorrectly administered during the previous month but the error had not been recorded on their medicines administration record (MAR). We also found that the temperature of the medicines storage area had exceeded the maximum safe temperature for the storage of medicines, but this had not been identified or acted upon. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people had been assessed and action taken to manage risks safely. The provider undertook appropriate recruitment checks before staff started work at the service and there were sufficient staff on duty to meet people’s needs safely. Staff were aware of the importance of seeking consent from people when offering support. We saw examples of mental capacity assessments having been conducted and specific decisions made in people’s best interests where they lack capacity, although improvement was required to ensure mental capacity assessments were reviewed on a regular basis in line with the requirements of the Mental Capacity Act.

People were involved in making day to day decisions about their care. They had care plans in place which reflected their individual needs and views. The provider had a programme of improvements in place and conducted a range of checks and audits. However improvement was required because checks on people’s MARs had not identified inaccuracies in recording, and because checks had not identified inaccuracies in the recording of freezer temperatures in the kitchen.

People were supported to access a range of healthcare services when required. Staff received regular training and supervision in support of their roles and spoke positively about the leadership of the service. The provider held regular staff meetings to help ensure the smooth running of the service.

People were protected from the risk of abuse because staff were aware of the types of abuse that could occur and knew the action to take if they suspected abuse. Staff were aware of the provider’s whistle blowing policy and told us they would escalate any concerns they had if necessary. The provider and manager were aware of their responsibilities under the Deprivation of Liberty Safeguards (DoLS) and had made authorisation requests to deprive people of their liberty where it was in their best interests.

People were treated with kindness and consideration by staff. They were supported to maintain a balanced diet and told us they enjoyed the food on offer at the service. Staff respected people’s privacy and treated them with dignity. The provider and manager sought people’s views through key worker sessions, service user meetings and an annual survey. People and relatives spoke positively a

Inspection carried out on 09 October 2015

During a routine inspection

This inspection took place on the 09 October 2015 and was unannounced. At the last inspection on 27 June 2014 the provider met all the requirements for the regulations we inspected.

The Drive is a care home which provides accommodation and support for up to twelve people with learning and physical disabilities. There were ten people using the service on the day of our inspection.

There was a registered manager in post at the time of our inspection. 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.

At this inspection we found a breach in regulations because risks to people’s health and safety were not always safely monitored or reviewed in a timely manner when incidents had occurred. You can see the action we have asked the provider to take in respect of this breach at the back of the full version of the report.

Medicines were stored securely and were safely administered but some improvements were required in the way they were recorded.

The registered manager undertook a range of audits to monitor the quality of the service and took action to address any issues found as a result. However, we found that audits of people’s support plans had not been conducted, and this had led to inconsistencies in some areas where support was required.

People, relatives and staff we spoke with told us that they felt the service was well led and that the registered manager would listen to any concerns they had and take appropriate action to address them. The provider had processes in place to enable people to give feedback about the service and the feedback received was positive. The registered manager had a good understanding of the requirements of their post and had submitted most notifications relating to areas of the service as required. However they were not aware of the requirement to notify CQC of any DoLS applications that had been authorised, and had not done so, although this issue was addressed following our inspection.

Appropriate recruitment checks were conducted before staff started work and people and relatives we spoke with told us there were enough staff on duty during each shift to safely meet people’s needs. We observed staff available to support people promptly when required. Staff were supported in their roles through regular supervision and training.

The provider had an appropriate policy and procedure in place to protect people from the risk of abuse and staff were aware of the potential signs of abuse. They also knew what action to take if they suspected abuse had occurred and how to escalate their concerns if needed. Staff were also aware of the action they should take in the event of an emergency.

People told us they received support in a caring and dignified manner and we observed staff working in a way that respected people’s privacy. People were supported to maintain relationships with their family and friends and were able to attend a range of social engagements and activities which promoted their independence.

Staff were aware of the need to gain consent from people when offering them support and people’s capacity to make decisions was assessed in line with guidance and the law. Staff had received training on the Deprivation of Liberty Safeguards (DoLS) and the registered manager was aware of the procedures for requesting DoLS authorisations where required.

People had been involved in menu planning were supported to maintain a healthy diet. They were involved in their care planning and received care that was personalised to meet their individual needs. They were also supported to access a range of healthcare professionals when needed and were aware of who they would talk to if they had any concerns. Relatives confirmed they were aware of the provider’s complaints procedure but told us they did not have any concerns about the service.

Inspection carried out on 27 June 2014

During a routine inspection

This inspection team was made up of an inspector. We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were aware of the importance of consent and people were asked for their consent before care was provided. People's needs were assessed and risk assessments were carried out before care was provided. These were regularly reviewed so that staff were aware of the best way to provide support.

The manager and deputy manager were available on a daily basis to oversee the staff, and monitor that people were being safely supported, for example with personal care and when travelling out in the community. Health care professionals and social services were involved in people's care planning and in responding to people's concerns when needed. There were always a minimum of five staff available to support people throughout the day and two staff at night to respond to night support needs.

There were arrangements in place to deal with emergencies and to make sure people were safe. People's health needs were included in their care planning to ensure they were healthy. Fire safety equipment and procedures were in place to ensure people would be kept safe in the event of a fire. The staff and manager were trained in protecting people from neglect or abuse and people told us they felt safe in their home.

Is the service caring?

We spoke with three people who used the service and observed staff working with people. People told us that the staff and manager were very caring and supportive. We saw that staff always took the time to stop and speak with people and spoke with them in a manner they best understood, speaking slowly and using pictures to help people to understand. One person said, “the staff are always helpful and respectful" and a relative said “they are brilliant and are very welcoming and friendly always.”

Is the service effective?

We saw from four people’s records we looked at that people's needs were assessed and a care plan was drawn up to meet those needs. A relative and one person we spoke with told us they were happy with the plan provided. Others we spoke with were unable to comment. Regular reviews were made of the plan and people were involved in the reviews. There were suitable policies in place for consent to care, for example in relation to the management of medication, the provider had fully considered the needs of people who may not be able to consent and had referred them to the local authority for assessment. We observed that staff were able to effectively communicate with people and that care plans addressed people’s individual care needs.

People who used the service were consulted for their views on a regular basis, which involved the person, their family or advocate and social services. Any changes they requested were included in a revised care plan.

Staff were provided with adequate support, guidance and training to do their job. They were experienced in supporting people with learning disabilities and used effective systems to communicate with people, such as including pictures in choices of food and activities and to ensure people knew familiar staff were scheduled to support them.

Is the service responsive?

People who used the service told us that the staff and manager always listened to their concerns and do something to help sort out any problems they were experiencing. People were provided with a range of enjoyable activities and changes were made when necessary to try out new activities. People's support plans were reviewed and changed when necessary in response to changing needs, for example in helping people with specialist eating support needs. People told us they had lots of interesting activities and that the staff listened when they wanted to do something different.

Is the service well led?

The registered manager was involved in direct care and worked with all the staff almost every day. They felt this meant they could identify any issues quickly and address them if they arose. Staff we spoke with told us that they felt the home was very well managed and that they received direction and training to allow them to support people at the home. Regular staff meetings and supervision sessions were held and staff said they felt able to raise any issues with the management openly and honestly.

People who used the service told us that they felt the manager was very good at managing the home and was always present to speak with them about any concerns.

There were a range of systems in place to monitor the quality of people's care, and to make sure any concerns about staff, management or the way in which care was delivered were addressed.

Inspection carried out on 7 February 2014

During an inspection to make sure that the improvements required had been made

On this occasion, we did not speak with people using the service as part of our inspection. We found the provider had made improvements, and appropriate arrangements were in place to ensure that people were fully consented regarding their care and treatment. People’s care was planned and delivered in line with their assessed care needs.

People were assessed regarding their ability to consent, and others such as family and healthcare professionals were involved in helping them to make decisions when necessary. All staff had received training in the process for ensuring people were consented about their care, and the process for involving them and others on their behalf in important decisions.

The provider’s policy had been updated regarding new admissions, and ensured that care assessments and plans for supporting peoples care needs were put in place before they came to live at the home. Staff told us they were updated regularly about people’s care needs and they now read and signed people’s care plans to show they understood how to safely provide support.

Inspection carried out on 20 June 2013

During an inspection to make sure that the improvements required had been made

We inspected the service on 20 June 2013 in order to follow up on enforcement action we had taken regarding the way the service managed medicines and record keeping. We found that the provider had systems in place for the safe management of medicines and records were accurate and fit for purpose. However we also found that people's care was not always delivered in a way which ensured their safety and well being.

We spoke with two people using the service who both said they were happy with the home and that the staff supported them. One person told us they enjoyed their work experience. We observed staff support people in a respectful way.

Inspection carried out on 23 April 2013

During an inspection to make sure that the improvements required had been made

Records were not all accurate and medications were not always stored or administered in line with the provider's own policy. The provider did not have appropriate arrangements in place to obtain consent from people.

People at the home told us they were happy and enjoyed living at the home. The relatives we spoke with said they felt their family members were well cared for by staff. A person told us their relative had been very unhappy at a previous placement but was now much happier since moving to The Drive. We observed staff delivering care in line with people's individual care plans. The provider followed their own recruitment policy to ensure that only suitable staff were employed by the service.

Inspection carried out on 26 November 2012

During a routine inspection

People we spoke with told us they liked living at the home and the staff treated them well. One person told us the home was "marvellous" and they could speak to the team leader on duty about anything they wanted. Another person told us they enjoyed attending the local college with staff. We observed staff offering people support to make choices and to attend college and appointments in the local community. Staff we spoke with had a good awareness of the needs and individual preferences of people they supported at the home. The home had appropriate safeguarding arrangements in place. However, medicines were not always appropriately recorded and stored, and people's records were not always accurate.

Inspection carried out on 15 March 2012

During a routine inspection

We spoke with four of the people living at the home and all of them told us that they were very happy and that the staff were very good. We did observe that the staff appeared to have good relationships and communicated well with the people they supported at the home.