Drake Court Residential Home

Drake Court is a residential care home providing personal care and accommodation for up to 29 people some of whom may live with dementia. The service was supporting 29 people at the time of the inspection in one adapted building.

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

Although some improvements had been made since our last inspection, risks to people were still not consistently well managed and left people at potential risk of harm. Improvements were being made to the management of people’s medicines. Mixed feedback was received about the staffing levels in place. Staff met peoples core needs, but support was task-focused and staff did not appear to have quality time with people. Systems were in place to protect people from risk of abuse. We were somewhat assured with the measures in place to prevent the spread of infection.

People did not always have the equipment available to meet their needs. Improvements were still required to ensure records contained detailed information about people including their end of life wishes. People knew how to raise concerns and told us staff knew them well and were responsive to their needs. There were some opportunities for people to engage in activities although this could be improved for people that lived with dementia. Systems were in place to support people to maintain contact with their loved ones.

Although we saw improvements had been made in the areas we identified during our last inspection, we found further improvements were required. The systems in place to monitor the service were still not detailed enough to enable the management team to identify shortfalls.

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 17 April 2019 ) and there were two 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 enough improvement had not been made or sustained, and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

Why we inspected

We received concerns in relation to care planning and staff not being responsive to peoples care needs. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed and remains as requires improvement. This is based on the findings at this inspection.

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.

We have found evidence that the provider needs to make improvement. Please see the safe, and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. The provider had started to take action to mitigate the risks we had identified.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to the management of risk and providing safe care, and the overall governance of the service.

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. 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.

We found the following examples of good practice:

¿ Visitors had their temperatures taken prior to entering the home and were required to sanitise their hands. Personal protective equipment was available for visitors to use.

¿ Measures were being put into place to re-introduce visits as soon as practicably possible with the construction of a visiting pod. Whilst visiting had been restricted the provider had ensured people continued to have contact with their family members through video and telephone calls. The management team had maintained regular contact with relatives to keep them informed about the wellbeing of their family member.

¿ Arrangements had been introduced for staff to appropriately social distance as much as possible, during breaks and staff handovers.

¿ People who had tested positive for Covid-19 self-isolated in line with current guidance.

¿ Staff were supported by the management team through periods of anxiety with regular phone calls to check on their wellbeing.

Drake Court Residential Home 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 care home accommodates up to 29 people in one adapted building. At the time of our inspection there were 28 older people living with dementia, many of whom had dementia.

A registered manager was 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.

People who required a texture modified diet were not always protected from potential harm as the risks to them were not being consistently managed. Care staff did understand how to manage other risks to people effectively although these required actions were not always documented in care plans.

The provider was not ensuring people were sufficiently protected as their governance and quality assurance systems were not always identifying issues of concern within the service. Records relating to people’s care were not always fully accurate and complete and this had not been identified.

People were supported by sufficient numbers of staff to keep them safe from harm. However, staff were extremely busy due to the increasing demands of people with challenging and distressed behaviours.

People were supported by a staff team who understood how to protect them from potential abuse. People’s medicines were managed safely and were administered as prescribed. We found infection control practices were strong and people were sufficiently protected.

People’s rights were protected by the effective application of the Mental Capacity Act 2005 (MCA). People’s day to day healthcare needs were met and people were happy with the food and drink they received.

People were supported by a staff team who were kind and caring in their approach. Care staff were committed to their roles, worked well as a team and were passionate about providing a good standard of care to people. People’s privacy and dignity was respected and their independence was promoted.

People or their representative when appropriate were involved in the development of their care plans. People’s needs were reviewed on a regular basis and the care they received was updated in line with their changing needs. People were getting access to an increasing range of leisure opportunities.

People understood how to make a complaint if this was required. People were involved in the development of the service and were consulted about any changes being made. People felt the registered manager was approachable and supportive. People were also supported by a care staff team who themselves felt valued and supported in their work.

The provider was not meeting the requirements of the law in relation to safe care and effective governance. You can see what action we told the provider to take at the back of the full version of the report.

Drake Court Residential Home provides accommodation and personal care for up to 29 people. At the time of our inspection there were 28 older people living at the service, most of whom were living with dementia.

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.

The provider had made improvements to quality assurance systems although further work was required to improve record keeping and some audits. Some improvements were required to risk management systems. Medicines administration records indicated creams were not always applied as prescribed. People also told us they felt more staff were required in the service.

People were supported by a staff team who had been reviewed for their suitability to work by the registered manager. We did find some improvements could be made to checks around staff member’s prior employment history.

People were supported by a staff team who understood how to protect them from potential abuse or mistreatment. People were supported by a care staff team who had the required skills to care for them effectively. The registered manager was making appropriate decisions in people’s best interests when they lacked capacity.

People’s nutritional needs were met and they enjoyed the food and drink they received. People’s day to day health needs were met.

People were supported by a care staff team who were kind and caring towards them. People enjoyed living at the service and felt valued and important. People were given choices around their care. People’s dignity was upheld and independence promoted.

People felt the care they received met their needs and preferences. People were able to access activities and leisure opportunities.

People felt able to complain if required. Where people raised concerns, their views were heard and action taken to make improvements. People felt the service was well-led. People were cared for by a staff team who felt supported in their roles by the management team.

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 those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drake Court Residential Home on our website at www.cqc.org.uk.

Drake Court Residential Home is a care home that provides accommodation and personal care for up to 29 people. At the time of our inspection there were 29 older people living at the service, most of whom were living with dementia.

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.

People were cared for by a staff team who were receiving the training and support required to support them effectively. People were enabled to consent to the care they received wherever possible. The staff and manager’s knowledge around the Mental Capacity Act 2005 (MCA) had improved although not all relevant decisions were being considered under the Act.

People were happy with the food and drink they received. Special dietary requirements were understood by care staff and met appropriately. People were supported to maintain their day to day health.

People felt the service was well managed, they felt able to raise concerns and felt they would be listened to and heard. People were supported by a staff team who felt well supported and motivated in their roles. People were protected by a developing quality assurance system that had begun to identify areas of risk and improvement required within the service. Further development was still required to ensure that all issues were identified and records were maintained accurately.

Drake Court is a residential home that provides accommodation and personal care for up to 29 people. At the time of our inspection there were 29 older people living at the service, many of whom were living with dementia. 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.

People were supported by a staff team who could recognise signs of abuse and knew how to report any concerns. Staff understood potential risks to people and how to keep them safe, although actions taken by staff were not always recorded in risk assessments. People were supported by sufficient numbers of staff who had been recruited safely for their roles. People’s medicines were administered and stored safely. However, medicines administration records did not always show that people received all of their medicines as prescribed.

People’s rights were not always upheld as decisions about the care of people who lacked capacity were not made in line with the Mental Capacity Act 2005. Where people were deprived of their liberty, the required legal applications had not been submitted to the local authority. People did not always receive the support they needed to prevent the risk of malnutrition. People did receive access to healthcare professionals such as doctors, dentists, chiropodists and opticians. People were supported by a staff team who were undertaking regular ongoing training to ensure their skills and knowledge were developed.

People were supported by a staff team who were kind and caring towards them. People were supported to make day to day choices about the care and support they received. People’s privacy and dignity was protected and promoted. People were supported to maintain their independence.

People were happy with the care they received. The care people received was under ongoing review and improvements were being made. People were supported to access leisure opportunities that they enjoyed. People developed relationships with others and enjoyed living in the service. People felt able to complain and raise concerns. They felt they were listened to and issues were resolved.

People knew who the registered manager was and felt they were approachable. People were involved in the development of the service. People were cared for by a staff team who were motivated in their role and felt supported by the registered manager. The registered manager had developed a positive staff team and an open, transparent culture within the service. A quality assurance system had been developed that had resulted in improvements being made throughout the service. This system was not yet effective in identifying and resolving all areas of concern that we found.

The provider was not meeting the regulation around the need for consent and good governance of the service. You can see what action we told the provider to take at the back of the full version of this report.

We looked at how people with diabetes were cared for. We spoke with two people about their care and their life within the home.

People we spoke with told us they were happy living in the home. One person said: "I love it here. I have been happy since day one. They are wonderful people, everyone is so nice and the food is good". Another person said: "It's lovely here, everyone is lovely".

We spoke with the manager and three staff about supporting people. We found that all the staff we spoke with were knowledgeable about signs and symptoms of both low and high blood sugar and actions required to ensure people's health and wellbeing needs were being met.

We found that there were improved systems in place to manage and respond to complaints and when needed, address people's concerns. People told us they were confident that if they had any concerns they would be addressed.

We found that the service had made the required improvements and was compliant with the regulations.

We found that care records required improvement to ensure that people's needs were identified.

The service had required systems in place to protect people from abuse and take appropriate action if any concerns about abuse were identified. We found that required improvements had been made since our previous inspection to safeguard people from abuse.

The home had systems in place to manage people's medicines and safeguard them from the risk of unsafe or inappropriate practice.

People told us that staff were caring and that staff assisted them when they needed it. One person said: "I have to ring the bell for staff to come to me in the night but they come quickly ". Another person said: "The staff are all grand". The service had additional staff since our previous inspection which meant that people had more social opportunities. There was a need to assess staffing requirements more proactively to ensure that the service continues to provide sufficient staff to meet people's needs.

The service had appropriate systems in place to enable people to raise concerns. Improvements were needed to how the service responded to any concerns to provide assurance that people's complaints would be appropriately addressed.