The unannounced inspection took place on 14 July 2016. We last inspected Drakelow House in June 2014 when we found the service was meeting the regulations that we inspected. Drakelow House provides residential care for up to 18 people, some of whom are living with early onset dementia. At the time of our inspection there were 16 people living at the service.
The service had 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 registered manager/owner had been involved with the service for over 20 years and was also known as the provider.
People told us they felt safe living at the service and relatives felt the same, however, we found areas of concern with regard to the safety of the building. Actions which needed to be finalised from a legionella and fire risk assessment which had been unduly delayed and not completed in a timely manner.
We found the cellar area of the service which was regularly used to be in need of repair and also posed an infection control risk to people. In this area we also found people’s archived records to be stored in an unsecure way.
Staff had been recruited safely, but the provider had not ensured that they continued to be supported and developed as there was a lack of supervision and appraisal records and gaps in staff refresher training.
Levels of staff at the service were inadequate to meet people’s needs. We found that the registered manager completed no dependency tool which would have assessed the level of staff required to meet the needs of people who lived at the service. Staff completed caring, cleaning, cooking and activity duties within their daily roles and this was not sustainable at current levels.
Activities were very limited for people who needed support with their social and psychological wellbeing as there was no dedicated staff to complete this task.
The provider completed a number of quality assurance checks, however these had not uncovered some of the issues that we had found during the inspection and needed to be updated and improved. Although the registered manager/owner was well known and liked, we found that they had very little oversight of the management of the service and this was mostly dealt with by the deputy manager who was not registered with the Commission.
Staff at the service managed people’s medicines safely and kept them stored in appropriate arrangements within one area of the service, but excess medicines were not stored in suitable conditions and we have asked the provider to address this.
Staff were able to explain their safeguarding responsibilities and there were procedures in place to support them, should they need to contact professionals in relation to this.
Emergency procedures were in place and monitored by staff at the service and accidents and incidents were recorded and checked for any learning to try and ensure the same accident did not happen again.
The living areas of the service were clean and tidy and the garden was well maintained with good stocks of established plants and shrubbery.
People enjoyed the food and refreshments that were prepared and staff helped those that needed support to ensure nutritional and hydration needs were met.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. People’s best interests’ were taken into account. There had been no DoLS applications to the local authority but staff knew how to make them should the need arise.
People’s health and wellbeing was monitored, with regular access to GP’s and other specialist healthcare as the need arose. A nurse and GP we spoke with told us the staff were responsive to people’s needs.
All of the people we talked with, and their relatives spoke highly of the staff and how well they cared for them. Relatives told us they always felt welcome. Staff had good relationships with people, they responded with a gentle and kind manner. Healthcare professionals thought that the staff were caring and would recommend the home.
Staff respected people’s privacy. They knocked on the door and waited for permission before entering people’s bedrooms and asked for consent before performing caring duties. They spoke to people with respect and addressed them how they preferred.
Care records reflected people’s individual needs and were regularly reviewed to monitor for any changes. The provider was in the process of updating these to improve the layout and format.
There had been no complaints to the provider recorded. People and their relatives told us they knew how to complain and would be able to if they thought there was a need. People were able to make choices.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Safe care and treatment, Person centred care, Staffing and Good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.