Drovers Call

Drovers Call is a 'care home'. It provides accommodation for older people including people living with dementia, providing personal and nursing care. The home can accommodate up to 60 people. At the time of our inspection there were 56 people living in the home. Accommodation is provided on three floors divided into five units.

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

Organisational governance and quality assurance systems had not been effective in monitoring and improving the quality and safety of the service. We found systemic failures with oversight and quality assurances processes, which posed significant risk to people.

There were indicators of a closed culture where chemical and physical restraint was disproportionately used. Staff had a lack of support or guidance on how to support people to lead inclusive and empowered lives.

The service failed to protect people from poor care and abuse. Staff had failed to identify, record and report incidents, additionally, the provider had failed to monitor the safety and quality of the service resulting in poor care and outcomes for people, with potential incidents of a safeguarding nature occurring.

Risk management was poor. A lack of support plans and assessments in place meant people's needs were not identified assessed or managed effectively. Ineffective care planning led to people experiencing increased periods of distress, restrictive practices and hospital admissions.

People did not always receive person centred care to meet their needs and preferences. Care files did not always have necessary support plans in place.

The service did not have enough staff, a high number of agency staff were used, significantly increasing the risk of inconsistent care.

People and their relatives provided mixed feedback, raising concerns with communication and staffing, but also highlighted they felt their relative received good care.

The service did not always follow or act in accordance with the Mental Capacity Act (MCA). The registered manager failed to apply for Deprivations of Liberty authorisations, meaning people were being deprived of their liberty without the legal authority and an infringement of their human rights.

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

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 requires improvement (published 15 May 2021).

Why we inspected

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.

The inspection was prompted in part due to concerns received about the use of restrictive practices, mental capacity assessments, governance and leadership. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to risk management, restrictive practices, safeguarding, leadership and governance at this inspection and placed urgent conditions on the provider’s registration.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Drovers Call is a 'care home'. It provides accommodation for older people including people living with dementia. The home can accommodate up to 60 people. At the time of our inspection there were 50 people living in the home. Accommodation is provided on three floors divided into five units.

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

Staff did not consistently follow infection control best practice. The service was clean and there were effective cleaning schedules in place being followed by the housekeeping staff. Staff had access to personal protective equipment.

Quality monitoring systems were in place but failed to reflect the current position or identify some of the issues we found on inspection.

Arrangements were not consistently in place to manage and administer people’s medicines safely.

People were usually 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.

The risks to people’s care were assessed and measures were in place to mitigate these risks. Environmental factors had also been risk assessed.

People were supported with adequate numbers of staff. Staff had received training for their roles. New staff were recruited safely.

Staff knew how to keep people safe from abuse and were confident to raise concerns with the registered manager or external agencies. When required, notifications had been completed to inform us of events and incidents.

Staff were supported and were kept informed of changes to practice.

People and their relatives knew how to raise a complaint and would feel confident to do so if needed.

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 12 August 2019).

Why we inspected

We received concerns in relation to skin care and nursing support. As a result, we undertook a focussed inspection to review the key questions of safe 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.

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 coronavirus 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.

The overall rating has changed from good to requires improvement. This is based on the findings at this inspection.

Follow Up

We will work alongside the provider and 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.

¿ A recent outbreak of COVID- 19 at the service had been managed well and the plans in place to support people had been utilised safely. There was clear zoning at the service and robust measures in place to reduce staff movement from unit to unit. Staff who tested positive or had displayed symptoms of COVID- 19 had shielded in line with the government guidance and were symptom free before returning to work.

¿ Information and guidance on COVID- 19 restrictions and infection control measures in place was available and visible for staff, people and visitors. Visitors were required to complete a questionnaire, have their temperature taken and wear Personal Protective Equipment (PPE) before entering the service following the provider’s infection prevention and control procedures.

¿ The manager had a clear communication programme in place for people, staff and relatives to keep them updated with issues related to COVID- 19.

¿ There were sufficient PPE supplies in place to ensure safe infection prevention and control practices were undertaken. Infection control policies had been amended to reflect current national guidance.

¿There was an enhanced cleaning programme in place and the service was visibly clean and well maintained. The registered manager had made adjustments to staff roles and how staff were deployed around the service to support the cleaning processes and reduce cross contamination.

¿ The provider had ensured staff were skilled in infection prevention and control (IPC). This included up to date training on infection control and 'Donning and Doffing', how to put on and remove PPE. This was followed up with regular observation of practice.

¿There was a testing programme in place for staff and people living in the service. This was to ensure if any staff or people who had contracted COVID- 19 and were asymptomatic, were identified in a timely way.

¿ Staff promoted and practised safe social distancing throughout the home as far as is reasonably practical. Clear systems were in place to shield and isolate people should outbreaks occur.

¿ People were supported to keep in touch with their relatives via telephone calls or video links. There was an electronic tablet on each unit to facilitate these calls. The provider had erected a Perspex screen in a conservatory area, which could be accessed from the garden to support relatives visits safely.

¿ People admitted to the service were supported in line with government guidance on managing new admissions during the COVID- 19 pandemic.

Drovers Call 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. It provides accommodation for older people including people living with dementia. The home can accommodate up to 60 people. At the time of our inspection there were 55 people living in the home. Accommodation is provided on three floors divided into five units.

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

Arrangements were in place to monitor and manage medicines. However, medicine records were completed inconsistently. Where people received medicines covertly (in drink or food without their knowledge) arrangements were not in place according to good practice guidance. We have made a recommendation about the management of some medicines.

The service placed people at the heart of the service and its values. It had a strong person-centred ethos. Staff and the service's management told us how they were passionate about providing person-centred care to people when they needed it.

We saw evidence of caring relationships in place, and a commitment to support people at difficult times with compassion.

Staff were aware of people's life history and preferences and they used this information to develop positive relationships and deliver person centred care. People felt well cared for by staff who treated them with respect and dignity.

There was a system in place to carry out quality checks. These were carried out on a regular basis to ensure the quality of care was maintained.

There was a range of activities on offer. People were supported to access the local community.

Care records were personalised and had been regularly reviewed to reflect people's needs. Care plans contained information about people and their care needs. People were supported to make choices and have their support provided according to their wishes.

People said they felt safe. There was sufficient staff to support people and appropriate employment checks had been carried out to ensure staff were suitable to work with vulnerable people.

People enjoyed the meals and their dietary needs had been catered for. This information was detailed in people’s care plans. Staff followed guidance provided to manage people's nutrition and pressure care.

People were supported by staff who had received training to ensure their needs could be met. Staff received regular supervision to support their role.

People had good health care support from professionals. When people were unwell, staff had raised the concern and acted with health professionals to address their health care needs. The provider and staff worked in partnership with health and care professionals.

The environment was adapted to support people living with dementia. The home was clean, and arrangements were in place to manage infections.

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

Arrangements were in place to involve people and their relatives in the running and development of the home. The provider had displayed the latest rating at the home and on the website. When required notifications had been completed to inform us of events and incidents.

More information is in the detailed findings below.

Rating at last inspection

The last rating for this service was good (published 6 January 2017). We have used the previous rating to inform our planning and decisions about the rating at this inspection.

At this inspection the rating remained Good.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

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.

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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered safely. We saw that staff obtained people’s consent before providing care to them. The provider did not consistently act in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision. People were encouraged to enjoy a range of social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service and 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?

People were treated with respect and dignity by the staff. People told us they felt safe.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place.

Staff were not adhering to the provider's policy for the safe disposal of medicines. Controlled medicines come under strict regulations under the Safer Management of Controlled Drugs Regulations (2006) and staff were not maintaining the register correctly. This could result in medicines not being stored safely.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they reflected their current needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People commented, "Staff help me when I need it" and "All my needs are being met."

People told us they felt their opinions were valued.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People received their prescribed medicines.

Is the service responsive?

People told us they could speak with staff each day and share their concerns. They told us staff acted quickly.

Is the service well-led?

Since our last inspection the registered manager, as named in this report, has left the provider's employment and they have recruited a new manager who has yet to submit an application to CQC as they have only been in post two weeks. The provider is aware the ex-registered manager's name will appear on this report.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed.. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We considered the findings of our inspection 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? This is a summary of what we found-

Is the service caring?

We saw how members of staff treated people and we observed care. We saw care was delivered effectively. When staff delivered care we saw it was provided in a respectful manner. We saw staff encouraged people to be independent.

When they supported people staff showed patience and we observed they supported people at the person's own pace.

We spoke with a relative who told us, they were happy with the care.

Is the service responsive?

We saw people's individual physical, mental and social care and support needs were assessed and met. This included people's individual choices and preferences as to how they liked to spend their day and receive their care.

We observed staff responded to people in a positive manner and respected their individual preferences.

We observed that staff obtained people's consent before they carried out any care.

We observed an occasion when a person required assistance and could not raise help for a period of 15 minutes.

Is the service safe?

Risk assessments regarding people's individual activities were carried out and measures were in place to minimise these risks.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards in place. Mental Capacity Act (2005) and Deprivation of Liberty Safeguards are laws protecting people who are unable to make decisions for themselves.

At the time of our inspection no one was deprived of their liberty.

We found where people lacked capacity their best interests had usually been considered, however the records did not always specify the areas which the best interest decisions related to.

Staff had been trained to understand when an application for a Deprivation of Liberty Safeguard should be made and how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic and there were processes in place to monitor this. The home was well maintained therefore not putting people at unnecessary risk.

The provider had a process in place for reporting and recording incidents and accidents. We observed actions from incidents had been acted upon to prevent these reoccurring. We saw there were two accidents which should have been reported to us and had not been. We spoke with the registered manager about this.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs.

We observed that staff did not always respond to people's needs in a timely manner. For example the mid-morning drink was not provided until 11.45 am.

Arrangements were in place to ensure people's physical health needs were met. For example, where people had specific issues with their health, such as the need for a specialist feeding regime, the care plans included guidance on how to deliver the care.

We found repositioning charts were completed fully.

Is the service well led?

Staff said that they felt supported and trained to safely do their job. Training plans were in place to ensure staff had the appropriate skills to meet people's needs.

Quality assurance systems were in place and people were listened to. Staff told us they felt able to raise issues and that these were acted upon. We saw satisfaction surveys had been carried out with people who lived at the home and their relatives. We spoke with a relative who told us they felt able to raise issues and if they needed to complain they would know how to do this.

We found gaps in some care records. For example two hospital transfer sheets were not completed which meant if people required hospital admission these would not have been ready for use.

We looked at the statement of purpose and saw it was up to date and reflected the care being provided.

We saw evidence that people were consulted before receiving care. One relative we spoke with told us, 'people talk to us about their care and discuss any changes with us.'

We asked people who used the service what they thought of the food that was provided for them, one person told us, 'there is nothing to complain about, it's very good.'

We asked people whether there were enough staff to meet their needs, a relative we spoke with told us, "there always seems to be enough staff around to ask if you need something.'

We saw evidence that staff were trained and supported in their work. One staff member told us, 'I feel well trained and supported in my role.'

We looked at the provider's complaints procedures and spoke to people about the process. A relative we spoke with told us, 'I feel confident enough to make a complaint.'

We looked at the provider's maintenance of records and found that they were adequately maintained and met people's needs.