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 the inspection. Drayton House provides personal care and accommodation for up to 19 older people, including people with dementia-related conditions. At the time of our inspection there were 13 people using the service. People had a variety of care and support needs related to their physical and mental health.

The inspection took place on 4 December 2017 and was unannounced. This meant staff did not know we were visiting.

At our last inspection in May 2016 we identified a breach of regulation. This breach was in respect of good governance in regards care records were not accurate putting people at risk of receiving inappropriate care. At this inspection we checked to see if the provider had made the improvements necessary to meet the requirements of the regulation. We found that improvements had been made.

We last inspected Drayton House on 20 May 2016 and rated the service as Requires Improvement. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions in safe and well led to a rating of good. We found that during this inspection the action plan had been followed and improvements had been made

The service had a registered manager who was on duty during the course of our visit. 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.

Staff were consistent in their knowledge of people's care needs and spoke with confidence about the individualised support people received to meet these needs. They told us they felt supported in their roles and had taken training that provided them with the necessary knowledge and skills. There was a plan in place to ensure staff received refresher training as deemed necessary by the provider.

Staff told us they received regular supervisions which were carried out by the management team. Staff told us that they found these useful. We reviewed records which confirmed this.

People felt safe. They were protected from harm because staff understood the risks people faced and how to reduce these risks. Measures to reduce risk reflected the person's preferences.

People told us they received the care and support they needed. They also told us they saw health care professionals when necessary and were supported to maintain their health by staff. People's needs related to on going healthcare and health emergencies were met and recorded.

People received their medicines as they were prescribed. Medicines were managed safely, securely stored, correctly recorded and only administered by staff who had been trained and assessed as competent to give medicines.

People could be confident that at the end of their lives they would be cared for with kindness and compassion and their comfort would be maintained. The staff worked with other organisations to make sure high standards of care were provided and people received the support and treatment they wished for at the end of their lives. One relative wrote, “Thank you for looking after my mum so kindly and being so caring.”

People described the food as good and there were systems in place to ensure people had enough to eat and drink. Where people changed their mind about what they wanted to eat they were offered alternatives.

People had support, care and time, when they needed it, from staff who had been safely recruited.

People were engaged with activities that reflected their preferences, including individual and group activities both in the h

Drayton House was last inspected on 13 March 2015 and we found they were meeting all requirements.

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 about how the service is run.

Drayton House provides care and support for up to 19 older people. At the time of the inspection there were 17 people living at the home.

The leadership within the home needed to be improved. The provider did not have an effective system to check the quality of care people received at the home. Peoples individual care records were not always up to date and the systems in place to evaluate and improve the care being given were not robust.

The systems and procedures for handling medicines were not safe and improvements were required. The system in place for the auditing of medication required improvement as it had not identified areas that needed improvement.

The risks people faced were not consistently acknowledged in people’s care records. When people were at risk of falling not all information available had been used to evaluate the on going risks. Care records were not always accurate and reliable.

People were able to raise concerns with the staff who took action to resolve the presenting issues. People had confidence in the staff to care for them in a professional and empathetic manner. People told us they felt safe. Relatives told us how caring and compassionate the staff were, one relative told us that staff understood it was the peoples home and they did everything to support them live a good quality of life.

People told us the staff were kind and caring and supported them in a caring way. One person told us “The staff are good to me, I have lived her for a number of years and the staff always are around to help. They help with the things I find difficult and take me to places I like to go" another said “The girls (staff) never rush me and let me take my time". A relative told us “You couldn’t wish for better staff, they are patient, thoughtful and willing to help with a smile, they go the extra mile”.

People and their relatives were given information about the running of the home and how they could comment on areas for improvement.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report

Some people who lived in the home had been assessed as not having capacity to make some choices and decisions which affected their lives.

We found systems and safeguards to ensure people experience appropriate care and support and to protect their human rights were not in place.

We spoke with people and observed that some people were unable to tell us what they thought about the care and support they received.

We found that people’s privacy, dignity and independence were respected and spoke with one person who told us the home was a “lovely home, homely and friendly”.

We found the interactions between the staff and people who lived at home were limited to staff carrying out tasks with people.

We found that people were treated with respect and kindness when interacting with staff.

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found staff had completed safeguarding training and demonstrated skills and knowledge in this area.

Staff told us they felt supported and received training, supervision and peer support.

We found the manager did not have effective systems in place to assess and monitor the quality of services.

The home did not have effective systems to maintain a minimum standard of cleanliness.

Following our inspection May 2012 we asked the provider to make a number of improvements in relation to involving people in decisions, treating people with respect, their care and welfare, the cleanliness of the home and the quality monitoring of the service. During this inspection ten people were accommodated at the home and we found that improvements had been made.

People were treated with consideration and respect and involved in decisions about their care. One person told us, “The staff are always very kind and helpful.” Another person said, “We get plenty of choices, they always offer choices.”

Care was delivered to meet people’s needs. One person told us, “I’m very well looked after here.” Another person said, “I get all the help I need.” We found that people’s needs were assessed and care was planned and delivered to meet these needs.

People lived in a clean environment. One person told us, “The room is very clean. They do it every morning.”

People were supported by capable staff. One person told us, “The staff are capable and kind. If you ask for something they do it.” We found that staff had received training in appropriate topics and were regularly supervised.

The provider had an effective system to monitor the quality of the service provision and people felt able to make suggestions as to improvements.

The inspection was unannounced and took place on 13 and 16 March 2015.

The service provides personal care and accommodation for up to 19 older people, including people living with dementia. Accommodation is provided over two floors accessible by a passenger lift and stair lift. The service is located within walking distance of the local town. At the time of inspection there were 13 people living at the home, including one person staying for respite care.

There was a registered manager in place, however at the time of inspection as they were due to leave their post, they were handing over to the owner, who would be applying to become the registered manager. The owner was previously the registered manager six years ago. 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 service was last inspected on 21 February 2014 and was found not meeting the standard relating to people’s consent to their care and the standard for how the quality of the service was assessed and monitored. There was also concern about the standard of cleanliness and hygiene. The registered manager sent us an action plan detailing how and when the issues would be addressed. At this inspection we found the service had completed the actions and made improvements. We found a strong ethos of choice had been developed for people who lived at the home, as well as formal consideration of people’s ‘best interests’, in accordance with the guidance and principles of the Mental Capacity Act 2005 (MCA).

An improvement plan for the redecoration and refurbishment of specific areas of the building had been completed. The cleanliness of the home was checked regularly and arrangements were in place to prevent the spread of infection. People told us they felt safe in the home and we saw they were supported to receive care safely. People benefitted from a safe and hygienic building.

The staff worked as a team to coordinate care and delivered the service based on an individual assessment of needs and a written and up to date care plan. Resources were in place to provide occupation and activities for people who chose this. Regular involvement with the local community was encouraged and facilitated for people who wanted this. Staff and management demonstrated care and concern for people’s mental, physical and emotional well-being.

One person who was unable to walk independently told us when they called staff, they came within one or two minutes and that the staff were, “a good crowd and very kind. Their care is fantastic.” Staff knew and understood people’s needs. People told us they were satisfied with the service. We observed people being consulted about all aspects of their care, being given explanations in a way they could understand and staff noticing when people wanted attention and offering this in an unhurried manner. One relative told us, “everyone is very happy and friendly, you can’t ask for more. The staff go out of their way to give people what they want.”

Where people had complex needs, the service engaged the relevant external professional such as the community nurse, the GP or the dietician, to ensure people’s care was managed appropriately.

Food was freshly prepared with choices offered for all meals. People were encouraged to express their likes and to try different tastes. People all told us they enjoyed the meals and we observed people were supported to eat a well-balanced diet.

Staff were positive about the service and told us they felt well supported and trained to carry out their duties effectively and safely. There were enough staff to meet people’s needs. Staff were recruited safely and provided with an induction into the service before taking on all the duties. More experienced members of staff supported less experienced members of staff and staff were regularly supervised.

There were no formal complaints recorded for the service. The service had recently given questionnaires to people’s representatives to get their feedback. Relatives commented on how accessible the registered manager was and how they felt they could approach them with questions or comments. Family and community involvement in the home was sought via events put on with invitations or through local events in the town, where people were helped to attend if they wished. Regular meetings were held with staff where issues and up to date guidance were discussed helping staff work as a team and share ideas about service improvements.