Archived: Drayton House

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.

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

Although people said they felt safe, safety and quality issues had not been identified or recognised in a timely way, which meant people's care and treatment needs were not always managed safely. Following a period of change in the provider at the service, the new provider's quality monitoring systems had lapsed. This meant they had not been used to monitor the quality and safety of the service people received or identify improvements needed. The lack of quality auditing of the service placed people at harm.

People did not always receive person centred care that met their individual needs or preferences. Although staff supported people in the least restrictive way possible and in their best interests, people were not always supported to have maximum choice and control of their lives.

People, relatives and staff all identified activities as an area for improvement. There were no activity coordinators at the service, which meant people spent long periods of time without any stimulation or having anything to occupy them. People were therefore at risk of social isolation. Following our inspection, the provider informed us they were planning to reinstate activity coordinators.

Risks relating to infection control were not all being managed safely. We were not assured that the provider was admitting people safely to the service, or that the service was being cleaned in line with national COVID-19 guidance. Some areas of the environment required updating to enable them to be effectively cleaned. The provider was admitting people to the service in line with national guidance.

Staff told us they had ample supply of Personal Protective Equipment (PPE). Although there was no outbreak of COVID-19 at the service and all staff were observed to wear a face mask, where staff had direct contact with people staff were not wearing gloves or sanitising their hands between interactions.

Staff were aware of the importance of good nutrition/hydration. However, we were not assured that people were being given choices in regard what they wished to eat and drink as records were not clear on what people had eaten or drank throughout the day. People told us the food was good, however they would like more hot drinks and snacks.

There was a risk that people were being supported by staff who had not been assessed as having the correct skills and knowledge to support them as training was out of date, and recruitment procedures had not been fully completed to make sure people were supported by staff with the

appropriate experience and character to support them.

People did not always receive person centred care that met their individual needs or preferences, and were at risk of social isolation. Activities were only offered on a Friday by a member of the kitchen staff. The provider informed us they planned to appoint new activity staff following our inspection.

People and families told us staff had developed positive and friendly relationships with people. However, we also identified issues about attitude and approach of some staff in treating people with dignity and respect.

People received the medicines they required and any risks specific to them were identified and guidance in place for staff to help keep them safe. People had their healthcare needs met. Health professionals told us timely and appropriate referrals were made to specialist teams.

Following our feedback, the provider voluntarily agreed not to admit people until further improvements are made. The service was being supported by the quality assurance team from the local authority to support the required improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This service was registered with us on 18 September 2020 and this is the first 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 improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

The last rating for the service whilst registered under the previous provider was good, published on 24/01/2018.

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.

Why we inspected

The inspection was prompted in part due to concerns about infection control, and environmental risk. A decision was made for us to inspect and examine those risks.

We identified six breaches of regulations in relation to person centred care, dignity and respect,

safe care and treatment, good governance, fit and proper persons employed and staffing.

Please see the action we have told the provider to take at the end of this report.

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 have requested 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.