Archived: Drayton Wood

Drayton Wood provides accommodation and support to a maximum of 37 people living with learning disabilities, autistic spectrum disorders, mental health or physical health care needs. At the time of our inspection there were 34 people living at the service.

The service consisted of five houses, with single bedrooms, ensuite and communal bathroom and toilet facilities and shared lounges, kitchens and dining areas. Houses also had rooms for staff when providing “sleep in” cover over night. There was a day service unit attached to one of the houses, this offered activities to people living at the service and people attending the service who lived in the community.

The service has been designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This is designed to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Environmental risks and concerns around medicines management were identified which did not always ensure people’s safety. Leadership and governance arrangements within the service were of concern, as they were not always identifying shortfalls and making changes to address them. There were breaches of regulation impacting on the quality of service provided to people.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; policies and systems in the service were not followed to support good practice.

People were accessing activities and the local community. Staff mainly treated people with kindness and were polite, and we received consistently positive feedback from people’s relatives about the care provided. However, we observed concerns in relation to how staff approached a situation during the inspection.

Management plans were in place for people needing support at the end of their life. The service told us they had good working relationships with health and social care organisations to ensure people received joined up care.

The registered manager encouraged people and their relatives to give feedback on the service, and areas for improvement through questionnaires and community meetings.

Rating at last inspection

The last rating for this service was Good, with Requires Improvement for the responsive key question (published 13 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of regulation in relation to safe care and treatment, consent to care and support, having good governance systems and processes in place. Staff training, competency checks, managerial oversight of staff performance and pre-employment safety checks. Please see the action we have told the provider to take at the end of this report.

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 and as part of this process we will ask for the service to provide a detailed improvement plan. We will work with the 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.

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.

At our last inspection on 10 and 14 March 2016 we found four breaches of the Health and Social Care Act 2008 and one breach of the Care Quality Commission (Registration) Regulations 2009. At this inspection we found improvements had been made, this meant the provider was no longer in breach of these regulations.

Safeguarding concerns and incidents were reported appropriately to the relevant agencies. Staff had a good understanding of adult safeguarding and how to identify and report concerns. Safeguarding plans were in place where people were considered at high risk. Restrictive actions to manage these risks had been agreed with people living in the service and were proportionate.

The provider had taken action to manage the risks to people relating to the premises. Risk assessments were in place for people and provided detailed guidance for staff. Staff had a good understanding of the risks to people’s wellbeing and took action to manage these. Medicines were being managed safely and people received their medicines as prescribed.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. Improvements had been made in this area. Staff and the management team understood the MCA and DoLS and its impact on the support they provided. People’s ability to make decisions and consent to their care was considered. Mental Capacity assessments and DoLS applications were carried out when required. It was not always clear how decisions in people’s best interests had been made. We have made a recommendation that the provider reviews this legislation and associated guidance to ensure they are acting in full accordance with the MCA.

The provider had established a number of effective measures and audits to monitor the quality of the service provided. They had ensured staff had a good understanding of their roles and responsibilities. Notifications were being submitted appropriately.

The culture in the home meant some staff did not always support people in a way that took into account their wishes. The provider was taking action to make improvements to the culture of the home and where they had identified this kind of practice.

Relatives and staff were positive about the support and leadership of the registered manager. People, relatives, and staffs opinions were sought and listened to.

There were sufficient staff to meet people’s needs, and this included enabling people to receive one to one support where required. Staff felt supported to provide effective care through the training and support that was provided.

People’s nutritional needs were met and staff encouraged people to eat healthily. Where there were concerns regarding people’s nutritional or health care needs staff liaised with relevant health care professionals to manage these needs.

People were supported by staff that cared for them and knew them as individuals. Some people living in the home had complex communication needs. The service was introducing a number of communication systems to help people express their wishes and feelings.

People were supported to be independent and participate in activities that took in to account their needs and preferences.

Care plans provided detailed guidance for staff on how to meet people’s needs and were updated when people’s needs changed. People and relatives knew how to raise concerns or complaints, although there was varied feedback on how responsive the service was to issues raised.

Drayton Wood is a service that provides accommodation and personal care to people with a learning disability or autistic spectrum disorder. The home is registered for up to 37 people. It is not registered to provide nursing care. Accommodation is provided in five separate houses. On the days of our visit there were 36 people living in the service.

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.

During this inspection we found four breaches of the Health and Social Care Act 2008 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

People’s safety had been compromised. Staff received training and were able to recognise signs of potential harm to people, but incidents were not always reported to the appropriate authorities. There were restrictive practices in place which were not always appropriate or respected people’s freedom. Risks to people from the premises were not robustly managed and people’s individual risk assessments were not always adequately reviewed. However, staff demonstrated they understood the risks to people living in the service and took action to manage them.

Medicines were not always administered safely. Records showed that there had been a number of medicine administration errors and incorrect practice. There was clear guidance for staff regarding medication administration and the medication we checked had been given appropriately.

There was a lack of understanding from staff and the management in the home regarding the Mental Capacity Act 2005 and Deprivation of Liberty safeguards. We found people’s capacity to make decisions was not assessed when required. When decisions were made on people’s behalf the correct guidance and legislation was not followed.

Support provided to staff to meet people’s needs was variable. Training was not always sufficient and some staff training was out of date. New staff received a full induction and the majority of staff we spoke with felt supported to meet people’s needs.

People were supported to maintain their health, this included supporting people to eat and drink healthily. Staff knew people’s individual dietary requirements. Risks regarding diet and nutrition were assessed and managed. Staff supported people to attend health care appointments and involved health and social care professionals regarding people’s care needs.

Staff appeared to know people living in the service well. They supported people to be as independent as possible. People received care from staff who were largely kind and compassionate, although people were not always treated or referred to in a kind way.

People’s care did not always appear to be reviewed when required. People and their relatives did not always appear to have opportunities to review and discuss their care plans. People and their relatives felt able to raise concerns and complaints, actions were taken to address and resolve these promptly.

Meaningful activities were on offer that supported people’s independence. People were supported to participate in activities of their choice and staff were proactive in supporting people to maintain important relationships.

Leadership within the home was not strong. There was a lack of guidance and support for staff. Staff were not always able to raise concerns and were not confident they would be protected if they did. There was a lack of systems for checking the quality of the service, this meant issues and areas for improvement had not been identified.

As part of this inspection we spoke with three people who used the service, the registered manager, the deputy manager and two care staff. We also reviewed records relating to the management of the home which included, four care plans, daily care records, training records and support/supervision records of staff.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

We spoke with three people who used the service. One person told us that, 'It's great here, people (the staff) are very good to me." Another person told us that they were about to go shopping. They said, "I often go out." The people we spoke with told us that they felt safe and well cared for.

We looked at four sets of care records which included risk assessments. Measures had been put in place to minimise any risks to people who used the service that ensured they were supported safely. For example, the risks to people's health through malnutrition or through being overweight had been assessed and appropriate diets and nutritional plans established where required.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. While no applications had needed to be submitted, policies and procedures were in place and under review. Relevant staff had been trained to understand when an application might be necessary and how to submit one.

We discussed staffing rotas which showed that there were sufficient numbers of trained and competent members of staff employed to provide people with safe and appropriate care as planned.

Is the service effective?

People who used the service were treated with dignity and respect. We observed staff during their day to day duties and saw that they were polite and kind to the people they were helping. They spoke appropriately to people who used the service and were aware of people with communication difficulties and the best ways of communicating with them. For example by using sign language or pictures when explaining things or offering choice.

People who used the service were supported in making choices. For example, what to wear or what main meal they preferred. Where people found it difficult to make choices for themselves, staff supported them in making decisions based on best interest principles.

Quality assurance measures were in place to identify the effectiveness of the service. This included questionnaires given to people who used the service, relatives, staff and visiting professionals. We saw audits of infection control measures, care and staff records, medication records, and the premises and environment.

Is the service caring?

We saw that people were cared for in an appropriate manner. Staff were attentive to their needs and familiar with peoples likes and dislikes. Records we looked at showed that people's needs had been assessed and details of likes, dislikes, routines and preferences were recorded.

New pen picture documents were being introduced to provide new staff and visiting professionals with information relevant to the person.

Is the service responsive?

The records we looked at showed that in most cases people's needs, choices and personal preferences had been assessed and planned for. Staff we observed during our inspection were familiar with each person and their individuality.

People's health and social care needs were attended to. People were supported to engage in a variety of vocational, social and recreational activities when they chose to do so. They were also supported to maintain contact with their friends and family members. A number of community based facilities were used to promote people's involvement in the community including day centres, the cinema, sports and recreational facilities.

Is the service well-led?

There were monitoring and reviewing systems in place to ensure that the quality of the care and support provided was high. Staff members told us that they had the training and support to safely do their job, which they said they enjoyed.

Members of staff and family members of people, who used the service, were provided with opportunities to make suggestions and comments to improve the quality of people's support and care. These were developed into an action plan which identified the improvements made and ensured that the service was able to confirm when required improvements were completed.

Staff we spoke with told us that they felt well supported and records showed that regular support and supervision was taking place.

We found that people were encouraged and supported to choose the day's menus. The menus that we saw were varied. People said that they were aware of their individual dietary needs and that these were catered for. They also said that they always had enough to eat and drink.

Equipment was effective and safe for people to use. In addition, the home was a safe place to work, live and visit because fire safety equipment was maintained and routinely checked.

Satisfactory recruitment systems were in place although the quality of the provider's recruitment policy needed some minor improvement. People who used the service demonstrated that they liked members of staff. Members of staff enjoyed their work, which they said they found rewarding.

Records were maintained and generally kept up-to-date to ensure that people were kept safe and well-cared for.

We found that people received care, treatment and support that met their needs and protected their rights. Care needs were assessed and support plans were put in place to meet the individual's needs. Care was delivered in line with what was planned. We spoke with four people using the service, one person told us "We're well looked after." Another person told us, "They look after us."

We found that people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The premises had been maintained in a good state of repair and in a way which promoted the dignity of people using the service. There was a team of maintenance staff in place to maintain the appearance, safety and suitability of the premises.

We found that there were enough qualified, skilled and experienced staff to meet people's needs. We spoke with two members of staff who told us that they felt the staffing level was sufficient to meet the needs of people using the service. The provider told us they had a number of bank staff in case of staff absence.

We found that the provider had an effective complaints procedure available, and complaints people made were responded to appropriately. There was a policy in place and complaints were investigated in line with this.