Archived: Drayton Village Care Centre

The manager of the service was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

We had previously inspected the location on the 6th, 7th, 8th and 13th December 2016 were we found records relating to care and people did not provide accurate information. In addition the audits carried out in relation to care records did not identify when information had not been recorded accurately. When a recording issue was noted, the audits completed in relation to the Medicine Record Administration (MAR) charts did not identify the actions taken to reduce the risk of the error occurring again.

Following the inspection we imposed a Warning Notice which required the provider to make improvements by 20th April 2017. The provider sent us an action plan which indicated that they would make improvements by this date.

We undertook an unannounced inspection of Drayton Village Care Centre on 27th April 2017 and we found improvements had been made.

We found improvements had been made in relation to the consistency of information recorded in the care plan folders and the manager reviews of all the information for each person were underway.

Global patient charts had been completed regularly and the manager was in the process of reviewing the frequency of a range of information should be recorded by care workers. The prescribed cream application records showed creams were applied as prescribed.

Weekly audits of MAR charts were carried out which identified when recording errors occurred and what action was taken.

Following the inspection on the 27th April 2017, and as a result of the improvements which we saw evidence of, the Warning Notice is no longer in place.

Drayton Village Care Centre is a nursing home and is part of Gold Care Homes. It provides accommodation for up to 59 older people in single rooms. The home is situated within a residential area of the London Borough of Hillingdon. At the time of our visit there were 45 people using the service.

The registered manager at the time of the April 2016 inspection had left the service and an interim manager had been responsible for the service for six months. At the time of the December 2016 inspection a new manager had been in post for seven weeks. The new manager was about to start the registration process with the Care Quality Commission. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

At our last comprehensive inspection of this service on 25, 26, 27, 28 and 29 April 2016, we found breaches relating to person-centred care, dignity and respect, safe care and treatment, receiving and acting on complaints, good governance, staffing and fit and proper persons employed. As a result of these, our concerns were sufficiently serious for us to impose a positive condition in relation to the provider providing us with regular updates on their progress in addressing the breaches we found with Regulations 9 (person-centred care), Regulation 12 (safe care and treatment), Regulation 17 (good governance), Regulation 18 (staffing) and Regulation 19 (fit and proper persons employed). At this inspection, we found there had been some improvement in relation to the breaches of Regulations 12 and 19 but sustained improvements had not been demonstrated and improvements had not been identified in relation to Regulations 9, 17 and 18 so we therefore decided to continue with the positive condition.

Staff had not received the necessary induction, training and support they required to deliver care safely and to an appropriate standard as identified by the provider.

Activities were organised at the home but some of these were not meaningful for people and when the activities coordinator was unavailable there were limited activities organised.

The records relating to care of people using the service did not provide an accurate and complete picture of their support needs.

The provider had a range of audits in place and we saw there had been some improvement in the information provided by these audits but we identified there were still issues in relation to the medicines audit as well as checks on records relating to care.

The provider had an administration of medicines policy and procedure in place but this sometimes was not followed by staff. We made a recommendation for the provider to review guidance on administration of medicines in a care home setting.

The provider had a recruitment process in place which was now being followed in relation to obtaining references which provided appropriate information on the applicant’s skills and experience.

Chemicals used for hairdressing and cleaning were now being stored securely and there was a reduced risk of cross contamination as equipment used to move people was no longer stored in two bathrooms and gloves were available for staff.

The provider had a process in place for the recording and investigation of accidents and incidents and this was now being followed.

Risk assessments now provided up to date information in relation to individual’s risks when receiving care.

Care workers now had more time which enabled them to appropriately support people’s emotional and social needs as the number of people requiring support had reduced and care workers were no longer focused on tasks.

Care plans were now written in a way that identified each person’s wishes as to how they wanted their care provided. Daily records were focused on the person receiving the support and not the tasks completed.

Due to the reduction in the number of people requiring support there were now enough care workers and nurses available to provide care.

The provider had policies, procedures and training in relation to the Mental Capacity Act 2005 and care workers were aware of the importance of supporting people to make choices.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

The provider had a complaints procedure in place and had responded to any complaints in line with their procedure.

Records relating to staff training, supervision and appraisal were now up to date.

People using the service had been sent a questionnaire asking for feedback on the quality of the service and the comments received had been positive.

Following our last inspection, we placed the service in special measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. As the provider has demonstrated improvements and the service is no longer rated as inadequate for any of the five questions, it is no longer in special measures.

Drayton Village Care Centre is a nursing home and is part of Gold Care Homes. It provides accommodation for up to 59 older people in single rooms. The home is situated within a residential area of the London Borough of Hillingdon. At the time of our visit there were 57 people using the service.

We previously inspected Drayton Village Care Centre on 29 and 30 January 2015 and we identified areas for improvement in relation to medicines management, staff training and supervision, and the Mental Capacity Act 2005.

At this inspection we found the provider had made some improvement but there were still areas for improvement with staffing training, supervision and appraisals.

The service had a registered manager in place but at the time of the inspection the registered manager was on extended leave. An interim manager had been in place at the home for four weeks. 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 a recruitment process in place but this had not been followed in relation to obtaining references which provided appropriate information on the applicant’s skills and experience.

Chemicals used for hairdressing and cleaning were not stored securely and there was a risk of cross contamination as equipment used to move people was stored in two bathrooms.

The provider had a process in place for the recording and investigation of accidents and incidents but this had not always been followed by the registered manager.

Risk assessments did not provide up to date information in relation to individual’s risks when receiving care.

There was a policy and procedure in place for the administration of medicines and they were stored safely but the administration of topical creams was not recorded accurately.

Staff had not received the necessary induction, training and support they required to deliver care safely and to an appropriate standard as identified by the provider.

There were not always enough staff to meet people’s care needs appropriately and safely.

Care workers were sometimes busy which resulted in them not appropriately supporting people’s emotional and social needs as they were focused on tasks.

Care plans were not written in a way that identified each person’s wishes as to how they wanted their care provided. Daily records were focused on the tasks completed and not the person receiving the support.

Activities were organised at the home but some of these were not meaningful for people and when the activities coordinator was unavailable there were limited activities organised.

The provider had a process in place for responding to complaints but this had not always been followed by the registered manager.

The records relating to care of people using the service did not provide an accurate and complete picture of their support needs.

The provider had a range of audits in place but these had not been carried out regularly to identify aspects of the service requiring improvement and action had not always been taken to address issues.

Care workers and nurses demonstrated a good understanding of the importance of supporting people to maintain their independence.

The provider had policies, procedures and training in relation to the Mental Capacity Act 2005 and care workers were aware of the importance of supporting people to make choices.

Each person using the service had an evacuation plan in place in case of an emergency. People felt safe when they received care and support.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking action against the provider for a breach of the Regulations in relation to person-centred care (regulation 9), dignity and respect (Regulation 10), the safe care and treatment of people using the service (Regulation 12), receiving and acting on complaints (Regulation 16), the good governance of the service (Regulation 17), staffing (Regulation 18) and fit and proper persons employed (Regulation 19). You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We spoke with eight people using the service, five relatives and visitors of people using the service and nine staff. The staff included the regional manager, a peripatetic manager, the outgoing and incoming deputy managers, the administrator, one nurse, two care staff and the housekeeper.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

People using the service confirmed they were happy with the service and were being cared for safely, and one person said 'I'm safe here.' Risks had been assessed and reviewed regularly to ensure people's individual needs were being met safely. Safeguarding and whistle blowing procedures were in place and staff were clear about reporting any suspicions of abuse. Staff had undertaken training on the Mental Capacity Act 2005 and were aware of their responsibilities in relation to Deprivation of Liberty Safeguards. Recruitment practices were robust and being followed.

Is the service effective?

Care records reflected people's individual needs, choices and preferences and staff had the knowledge and skills to meet these. People had access to healthcare professionals to meet their needs. People told us they were happy, well cared for and treated with respect. People and their representatives had been involved with the development of the care records, so they could express their views and have these included.

Is the service caring?

Staff treated people in a gentle and caring manner when supporting and assisting them with daily routines. Privacy and dignity were respected. Meetings were held and staff listened to people so changes could be made to better meet people's wishes. Comments we received from people included 'all the staff are excellent', 'I can't praise the staff enough.' and from a member of staff about people using the service, 'all are unique and have different needs.'

Is the service responsive?

People's care records had been reviewed regularly so any changes to their care were identified and records maintained up to date. People and their families said they would be confident to raise any concerns that arose. Recent meetings had taken place for people using the service and for relatives and people commented these had been positive and they had been listened to. Comments about the service included 'very nice place, staff all very nice' and 'I like it here and I'm happy here.'

Is the service well-led?

The previous manager had recently left the service and the provider was actively recruiting for a new manager. The regional manager said they wanted to appoint the right person for the job and interviews were being carried out. At the time of inspection a peripatetic manager was in post and the regional manager was also regularly working at the home.

The new deputy manager had experience working in other services owned by the provider. This meant they had experience of the systems and documentation in use and were undergoing a handover from the outgoing deputy manager to familiarise them with the service. Systems to monitor the quality of the service were in place and where shortfalls were identified action plans were drawn up to address them.