Archived: Drayton House

Updated 26 June 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors

Service and service type

Drayton House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The manager had applied to the Care Quality Commission (CQC) to become the registered manager and was being processed. The day after the inspection we were informed by the provider the manager had withdrawn their application and would be leaving the service and they would be recruiting a new manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received from the provider and others since the last inspection such as an action plan and a training matrix and feedback from local professionals. We used all of this information to plan our inspection.

During the inspection

We met the majority of people who lived at the home and spoke in depth with three of them. We looked at four people's care records and at medicine records.

We spoke with the manager and the nominated individual (the person responsible for supervising the management of the service on behalf of the provider), and with five other staff which included a senior care assistant, care staff, housekeeping and the administrator.

We reviewed a range of records, this included five people’s care records, four staff files in relation to recruitment and at records of staff training and supervision. We reviewed quality monitoring records, such as checklists, handover records, cleaning schedule, complaints folder, accident and incidents and maintenance records.

After the inspection

We continued to seek clarification from the provider’s representative to validate evidence found. We held a meeting with the provider, provider’s representative and manager on 26 June 2021 to feedback our findings. We contacted the local authority to make them aware of our findings.

Updated 26 June 2021

About the service

Drayton House is a residential care home providing personal care for up to 19 people, including older people and people who may be living with dementia. At the time of our inspection 13 people were living at the service. The home is a grade II listed building in the middle of the town of Bridport. Accommodation is over two floors with stair lift access, some rooms had en-suite facilities others did not.

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

People were at risk of harm because the systems in place to ensure they received safe and appropriate care were not effective. After the last inspection in March 2021 the provider told us they would ensure appropriate action was taken in response to all concerns we identified at the inspection. This had not happened.

Some improvements had taken place in relation to staff training and recruitment, but people’s experience had not improved or been considered. We found further concerns at this inspection in relation to care plans and individual risk assessments not being reviewed or updated.

The provider's quality assurance processes remained ineffective. Audits had not been completed to identify care plans and risk assessments had not been reviewed or updated. Therefore accurate, complete and contemporaneous records had not been kept for people. This meant that people were at risk of not receiving the care they required in a consistent way.

People remained at risk of infection due to poor infection control processes in the home. Records in relation to cleaning schedules were not complete to enable monitoring or demonstrate compliance with good practice. There was no oversight to ensure cleaning was undertaken on days the cleaner was not working and the visitor process was not being followed in relation to COVID-19 checks.

The oversight of the day to day maintenance by the provider was still not always effective and people remained at risk.

Fire management did not ensure people would be safe in the event of a fire.

A reduction in staff levels in the afternoon had increased the workload for staff. Staff told us they needed to rush to get everything completed. This meant people were not getting good quality care. The provider’s representative told us this reduction was a misunderstanding and would be rectified.

Medicines continued to be safely managed and staff understood how to identify and report abuse and spoke with care about the people they supported.

After our last inspection the provider had voluntarily agreed not to admit new people to the home until further improvements were made. This agreement remained in place. The service was being supported by the quality assurance team from the local authority to help ensure the required improvements were made.

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 (report published 14 May 2021) with six breaches of regulations. At this inspection improvements had not been made and the service had deteriorated to inadequate.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We followed up six ongoing breaches of safe care and treatment and good governance found at the previous focused inspection.

The inspection was prompted in part due to a safeguarding concern and concerns about infection control.

We have found evidence that the provider needs to make improvements. 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.

Ratings from previous comprehensive inspections for the key questions we did not inspect were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drayton House 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 breaches in relation to safe care and treatment, staffing and overall governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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.