Drakelow House Residential Home

Drakelow House Residential Home is a care home providing residential care to 14 people aged 65 and over at the time of the inspection. The service can support up to 18 people.

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

People felt safe. People were supported by staff who had been trained to identify and report safeguarding concerns. Staffing levels were at a minimum on the day of the inspection. However, this did not negatively impact on the standard of care. People were safely supported to take their medicines.

People's healthcare needs were monitored. People had access to appropriate support from a variety of health care professionals. People with specialist dietary needs were supported accordingly. 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.

People and their relatives were positive about the service. Staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld. The service could provide people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

People told us they wanted more activities at Drakelow House Residential Home. People received care that was responsive to their needs. Staff understood the needs of people they were supporting. Care plans included person-centred information. People’s future care needs were not always captured. We have made a recommendation about this. There was an appropriate system in place to monitor complaints.

There was a positive and open culture. Staff roles and responsibilities were clear. The service worked in partnership with a variety of agencies to ensure people received the support they needed. People were happy with how the service was managed. Staff felt well supported by the management team and held them in high regard.

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 05 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

We last inspected the service on 14 July 2016 when we rated the service as Requires Improvement overall.

At that time we found the service was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to governance, the safe and proper management of medicines, care workers, risk assessments, infection control and meeting people’s psychological and social needs.

Following the inspection the provider sent us an action plan detailing how the identified breaches would be addressed. At this inspection we found that the provider was now meeting all of the requirements of these regulations. This inspection was to check improvements had been made following the last inspection and to review the ratings.

Drakelow Residential Care Home is registered with the Care Quality Commission (CQC) to provide residential care and support for up to 18 older people. A small number of people who were using the service were living with the early stages of dementia. The home provides permanent and short stay care residential services. Accommodation is provided over two floors and the first floor can be accessed via a passenger lift. All bedrooms are single occupancy with nine having en-suite facilities. The home is a detached building set in its own grounds and is located in Heaton Moor, Stockport. At the time of the inspection 12 people were using the service.

A registered manager was in place at the time of the 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. The registered manager is also the registered provider and owner of Drakelow House.

We saw many positive and caring interactions between care workers and people who used the service to make sure people’s wellbeing was promoted.

People who used the service and their relatives were complimentary and positive about the support provided and attitude of the care workers team and management. They felt the overall care provided was very good and the environment was homely.

During both days of the inspection we saw people were supported by sufficient numbers of care workers. Care workers we spoke with told us they had undergone a thorough recruitment process and had undertaken employee induction and training appropriate to the work. This helped to make sure the care provided was safe and responsive to meet people’s identified needs.

Care workers confirmed they had received safeguarding and whistleblowing training (raising a concern about a wrong doing in the workplace) and knew who to report concerns to if they suspected or witnessed abuse or poor practice. We saw records to show care workers received regular supervision to help make sure they were carrying out their duties safely and effectively.

We saw written evidence that people and their relatives were involved in the decision making process at the initial assessment stage and during their care needs review.

Care records were in place which reflected peoples identified health care and support needs. Information about how people wanted to be supported and their dietary requirements were also included in the care records we examined.

Systems to make sure the safekeeping and administration of medicines were followed and monitored were in place and reviewed regularly. Medicines were stored safely and administered by designated trained care workers. Any specific requirements or risks in relation to people taking particular medicines were clearly documented.

Complaints were addressed by the registered manager. People who used the service and their relatives told us they knew how to make a complaint and felt confident to approach any member of the care workers team if they needed to.

Systems were in place to monitor the quality of the service. People using the service and their relatives had been provided with surveys to ascertain their views and opinions about their satisfaction of the service provided. Any feedback received was noted and used to make improvements to the service and the care and support provided.

Drakelow House provides residential care for up to 18 people, some of whom are living with early onset dementia. At the time of our inspection there were 16 people living at the service.

The service had 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 registered manager/owner had been involved with the service for over 20 years and was also known as the provider.

People told us they felt safe living at the service and relatives felt the same, however, we found areas of concern with regard to the safety of the building. Actions which needed to be finalised from a legionella and fire risk assessment which had been unduly delayed and not completed in a timely manner.

We found the cellar area of the service which was regularly used to be in need of repair and also posed an infection control risk to people. In this area we also found people’s archived records to be stored in an unsecure way.

Staff had been recruited safely, but the provider had not ensured that they continued to be supported and developed as there was a lack of supervision and appraisal records and gaps in staff refresher training.

Levels of staff at the service were inadequate to meet people’s needs. We found that the registered manager completed no dependency tool which would have assessed the level of staff required to meet the needs of people who lived at the service. Staff completed caring, cleaning, cooking and activity duties within their daily roles and this was not sustainable at current levels.

Activities were very limited for people who needed support with their social and psychological wellbeing as there was no dedicated staff to complete this task.

The provider completed a number of quality assurance checks, however these had not uncovered some of the issues that we had found during the inspection and needed to be updated and improved. Although the registered manager/owner was well known and liked, we found that they had very little oversight of the management of the service and this was mostly dealt with by the deputy manager who was not registered with the Commission.

Staff at the service managed people’s medicines safely and kept them stored in appropriate arrangements within one area of the service, but excess medicines were not stored in suitable conditions and we have asked the provider to address this.

Staff were able to explain their safeguarding responsibilities and there were procedures in place to support them, should they need to contact professionals in relation to this.

Emergency procedures were in place and monitored by staff at the service and accidents and incidents were recorded and checked for any learning to try and ensure the same accident did not happen again.

The living areas of the service were clean and tidy and the garden was well maintained with good stocks of established plants and shrubbery.

People enjoyed the food and refreshments that were prepared and staff helped those that needed support to ensure nutritional and hydration needs were met.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. People’s best interests’ were taken into account. There had been no DoLS applications to the local authority but staff knew how to make them should the need arise.

People’s health and wellbeing was monitored, with regular access to GP’s and other specialist healthcare as the need arose. A nurse and GP we spoke with told us the staff were responsive to people’s needs.

All of the people we talked with, and their relatives spoke highly of the staff and how well they cared for them. Relatives told us they always felt welcome. Staff had good relationships with people, they responded with a gentle and kind manner. Healthcare professionals thought that the staff were caring and would recommend the home.

Staff respected people’s privacy. They knocked on the door and waited for permission before entering people’s bedrooms and asked for consent before performing caring duties. They spoke to people with respect and addressed them how they preferred.

Care records reflected people’s individual needs and were regularly reviewed to monitor for any changes. The provider was in the process of updating these to improve the layout and format.

There had been no complaints to the provider recorded. People and their relatives told us they knew how to complain and would be able to if they thought there was a need. People were able to make choices.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Safe care and treatment, Person centred care, Staffing and Good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive to people's needs?

Is the service well?

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 family members, the staff supporting them and looking at records. We also contacted Stockport Local Authority Quality Assurance team.

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

Is the service safe?

Training was in place to protect the people who received a service at Drakelow House. The training consisted of moving and handling, safeguarding adults and health and safety.

The three staff we spoke with had National Vocational Qualifications (NVQ) and the assistant manager had the Registered Managers Award. This helped to ensure that the staff team had the skills to meet people's needs.

The staff members had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This training ensured that the staff team were aware of the need to make sure that people who are not able to make decisions or choices are protected and kept safe.

Drakelow House was clean, tidy and free from unpleasant odours. We were also able to see gas and electric safety certificates and other service records that ensured the property and equipment was safe.

Is the service effective?

We saw from talking with the care workers and assistant manager and looking at the care plans that there was a good understanding of people's needs and that they knew the people well.

The two family members we spoke with told us that they were kept informed and were involved in the care plan. They also told us that they had no complaints and if they had they would feel comfortable talking with the staff and manager.

There was equipment in place to assist in meeting people's day to day care needs such as a hoist and a passenger lift to the first floor.

The home did not offer a service to accompany people on hospital visits and family members were asked to do this. This meant that people had to go on their own if there were no family members or advocates able to go with them. We were aware of the difficulties with a small staff team; however the provider might like to consider a way of offering this service.

Is the service caring?

All of the people, including family members, we spoke with were happy with the care provided. One family member told us; 'I can talk to staff and there is nothing to be worried about, my relative always has the GP when necessary and we are made to feel welcome, I have no concerns'. Another person who lived at the home said; 'I very much like living here, I have no complaints and I am very settled'.

We saw during our visit that the people who lived there and the staff team were friendly and relaxed in each other's company.

Is the service responsive to people's needs?

We saw that people's needs were assessed before they were offered a place at Drakelow House and that their personal preferences were documented.

We also saw that care plans and risk assessments were in place that reflected the person's care needs to ensure that they received appropriate care.

We were told by people who lived at Drakelow House at the time of our visit that the staff contacted the GP if they were not feeling well.

Is the service well led?

The provider is also the registered manager of Drakelow House and has the National Vocational (NVQ) Registered Managers award.

Resident and staff meetings took place yearly and minutes were taken which the staff members had to sign to show that they were aware of people's views.

Relative and resident surveys were conducted each year. From the replies an analysis was completed and action taken as required.

We looked at three care records and found that these were updated regularly.

We saw risk assessment checks were carried out and recorded as required.

We spoke with two staff who were able to describe the processes in place to ensure that sensitive information remained confidential.

We spoke with three people who used the service who told us they had no concerns regarding the safe keeping of any documentation relating to them.

We looked at a selection of care records. These contained information regarding the needs and wishes of individuals and the care that they had agreed with the service.

We spoke with people who lived at the home who all told us that they were happy with care and support provided.

We spoke with one family member who said they considered the care to be good.

We found that the home had sought expert advice and had carried out appropriate environmental risk assessments and there were systems in place to monitor the quality of the service provided.

We found that systems were in place to ensure people were protected from the risk of harm and abuse and we saw evidence to show that people were able to make comments, suggestions and complaints with timely feedback provided by the service.

We spoke with three members of staff who all told us that they enjoyed working at the home and that they felt well supported in their roles. They told us that they received appropriate training and development activities to enable them to deliver safe and effective care.

We found that although routine monitoring was carried out, this was not documented

People informed us they had been asked by the staff about the care and support they needed to ensure they kept in good health. A person said, I have all the help I need and I can retain my independence which I like.'

People confirmed they could choose how to spend their day and staff respected their wishes.

We talked with people about the number of staff on duty during the day and at night time, as the care staff undertook cleaning, laundry duties and also cooked the meals each day. People we spoke with said there were enough staff to help them despite the staff having to undertake cleaning and cooking duties. One person told us they thought the home would benefit from a cook, as the staff were busy. People confirmed the staff were kind and helpful and they did not have to wait for assistance when they asked for it. A visitor reported the staff were 'Patient and brilliant.'

The home's complaint procedure was displayed for people to see and people we spoke with told us they would speak up if they were worried about anything in the home.