This inspection took place on 15 December 2016 and was unannounced. Drovers call provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 60 people who require personal and nursing care. At the time of our inspection there were 42 people living at the home. The service is provided across three floors however currently only two floors were used.

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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered safely. We saw that staff obtained people’s consent before providing care to them. The provider did not consistently act in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision. People were encouraged to enjoy a range of social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

We carried out an unannounced focussed inspection of this service on 3 September 2015. A breach of legal requirements was found. The provider was not meeting the standards of care we expect in relation to ensuring that appropriate arrangements for the management of medicines was in place.The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused inspection on 17 December 2015 to check that they had followed their plan and to confirm that they had now met legal requirements with regard to the management of medicines. At our inspection on the 17 December 2015 we found the provider had made improvements in the areas we had identified.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drovers Call on our website at www.cqc.org.uk.

Drovers Call provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 60 people who require personal and nursing care. Accommodation is provided in two units an upstairs and downstairs unit. At the time of our inspection there were 31 people living at the home.

At the time of our inspection there was not a registered manager in post. The home has had four registered managers in the past year. The current manager was in the process of applying to be the registered manager. 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.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. The management and administration of medicines was adequate.

People received their medicines in a timely manner. We found that people were getting their medicines as prescribed. However we found that records relating to the administration of warfarin were not clear and it was difficult to identify what dosage people had been given.

We carried out an unannounced focused inspection of this service on 11 May 2015. Breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At the last inspection on 11 May 2015 we found that people were not treated with dignity and respect and care records were not consistent in ensuring people’s care was planned and delivered to meet their individual needs. We also found that the provider did not have effective systems to assess and monitor the quality of service provided to people. We undertook a further focused inspection on 1 December 2015 to check that they had followed their plan and to confirm that they now met legal requirements. At our inspection on 1 December 2015 we found the provider had made improvements in some of the areas we had identified and now met legal requirements.

This report only covers our findings in relation to those requirements. You can see what action we have told the provider to take at the back of the full version of this report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drovers Call on our website at www.cqc.org.uk.

Drovers Call provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 60 people who require personal and nursing care. Accommodation is provided in two units, an upstairs and downstairs unit. At the time of our inspection there were 31 people living -in the home.

At the time of our inspection there was not a registered manager in post. The home has had four registered managers in the past year. The current manager had been in post for seven days and was in the process of applying to be the registered manager. 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.

People were treated with dignity and respect and staff responded in an appropriate manner to people. There were sufficient staff to meet people’s needs and staff were kind to people when they were providing support. Staff in the upstairs unit told us there were occasions when they thought there were insufficient staff.

Systems were in place to assess and monitor the quality of the service to people and were effective. The provider told us what actions they would take to make improvements and we found at this inspection that the improvements had been sufficient to meet legal requirements. The provider had started to carry out audits out on a regular basis and action plans were in place to address any concerns and issues identified.

Care records had been reviewed and apart from two records we looked at they reflected people’s care needs consistently.

We carried out an unannounced focussed inspection of this service on 12 May 2015. Breaches of legal requirements were found. After the focussed inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At the last inspection on 12 May 2015 we found that the provider was not meeting the standards of care we expect in relation to ensuring that appropriate arrangements for the management of medicines are in place. We undertook this focused inspection on 3 September 2015 to check that they had followed their plan and to confirm that they now met legal requirements with regard to the management of medicines. At our inspection on the 3 September 2015 we found the provider had not made improvements in some of the areas we had identified.

This report only covers our findings in relation to those requirements. You can see what action we have told the provider to take at the back of the full version of this report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drovers Call on our website at www.cqc.org.uk.

Drovers Call provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 60 people who require personal and nursing care. Accommodation is provided in two units an upstairs and downstairs unit. At the time of our inspection there were 36 people living at the home.

At the time of our inspection there was not a registered manager in post. The home has had four registered managers in the past year. The current manager was in the process of applying to be the registered manager. 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.

People were not protected against the risks associated with medicines because the provider had inappropriate arrangements in place to manage medicines. The management and administration of medicines was inadequate. The provider told us what action they would take to make improvements. However we found at this inspection that this action had not been completed and medicines were not managed appropriately.

People did not receive their medicines in a timely manner. We found that people weren’t getting their medicines as prescribed.

We carried out an unannounced comprehensive inspection of this service on 9 and 11 February 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At the last inspection on 9 and 11 February 2015 we found that the provider was not meeting the standards of care we expect in relation to ensuring people’s care was planned and delivered to meet their individual needs, maintaining appropriate standards of cleanliness and hygiene and did not have appropriate arrangements for the management of medicines. We also found that the provider did not ensure staff were appropriately supported with training and supervision and did not have effective systems to asses and monitor the quality of service provided to people. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. At our inspection on the 12 May 2015 we found the provider had not made improvements in some of the areas we had identified.

This report only covers our findings in relation to those requirements. You can see what action we have told the provider to take at the back of the full version of this report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drovers Call on our website at www.cqc.org.uk.

Drovers Call provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 60 people who require personal and nursing care. Accommodation is provided in two units an upstairs and downstairs unit. At the time of our inspection there were 46 people living at the home.

At the time of our inspection there was not a registered manager in post. The home has had four registered managers in the past year. The current manager had been in post since March 2015 and was in the process of applying to be the registered manager. 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.

People were not protected against the risks associated with medicines because the provider had inappropriate arrangements in place to manage medicines. The management and administration of medicines was inadequate. The provider told us what action they would take to make improvements however we found at this inspection that this action had not been completed and medicines were not managed appropriately.

People did not receive their medicines in a timely manner. We found that people weren’t getting their medicines as prescribed. We observed that medicines were not given in a safe manner to ensure that people received the appropriate medicines.

People were not always treated with dignity and respect and staff did not always respond in an appropriate manner to people. There were sufficient staff to meet people’s needs and staff were kind to people when they were providing support. Staff in the upstairs unit had a good understanding of people’s needs.

Systems to assess and monitor the quality of the service to people were not effective. The provider told us what actions they would take to make improvements and we found at this inspection that the improvements had not been sufficient to meet the regulation. Although audits were carried out on a regular basis and action plans put in place to address any concerns and issues they did not always identify issues of concern. For example, the medicine audits did not identify the issues raised at the inspection.

Systems and processes had been put in place to ensure that infection control risks were managed.

Our inspection team on this occasion was made up of one inspector. We did this inspection as a follow up from compliance actions set at the inspection on 29 April 2014.They concerned outcomes 4 (care and welfare of people who use the service) and 21(records). We also had concerns raised to us since the last inspection from individuals and from safeguarding investigations from the local authority safeguarding team and added outcomes 6 (cooperating with other providers),9 (management of medicines) and 13 (staffing). We considered our evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place.

Staff were not adhering to the provider's policy for the safe disposal of medicines. Controlled medicines come under strict regulations under the Safer Management of Controlled Drugs Regulations (2006) and staff were not maintaining the register correctly. This could result in medicines not being stored safely.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they reflected their current needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People commented, "Staff help me when I need it" and "All my needs are being met."

People told us they felt their opinions were valued.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People received their prescribed medicines.

Is the service responsive?

People told us they could speak with staff each day and share their concerns. They told us staff acted quickly.

Is the service well-led?

Since our last inspection the registered manager, as named in this report, has left the provider's employment and they have recruited a new manager who has yet to submit an application to CQC as they have only been in post two weeks. The provider is aware the ex-registered manager's name will appear on this report.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed.. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

The summary is based on our observations during the inspection, speaking with three people who used the service, their relatives and the staff who supported them. We also looked at five records and observed care.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

We saw how members of staff treated people and we observed care. We saw care was delivered effectively. When staff delivered care we saw it was provided in a respectful manner. We saw staff encouraged people to be independent.

When they supported people staff showed patience and we observed they supported people at the person's own pace.

We spoke with a relative who told us, they were happy with the care.

Is the service responsive?

We saw people's individual physical, mental and social care and support needs were assessed and met. This included people's individual choices and preferences as to how they liked to spend their day and receive their care.

We observed staff responded to people in a positive manner and respected their individual preferences.

We observed that staff obtained people's consent before they carried out any care.

We observed an occasion when a person required assistance and could not raise help for a period of 15 minutes.

Is the service safe?

Risk assessments regarding people's individual activities were carried out and measures were in place to minimise these risks.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards in place. Mental Capacity Act (2005) and Deprivation of Liberty Safeguards are laws protecting people who are unable to make decisions for themselves.

At the time of our inspection no one was deprived of their liberty.

We found where people lacked capacity their best interests had usually been considered, however the records did not always specify the areas which the best interest decisions related to.

Staff had been trained to understand when an application for a Deprivation of Liberty Safeguard should be made and how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic and there were processes in place to monitor this. The home was well maintained therefore not putting people at unnecessary risk.

The provider had a process in place for reporting and recording incidents and accidents. We observed actions from incidents had been acted upon to prevent these reoccurring. We saw there were two accidents which should have been reported to us and had not been. We spoke with the registered manager about this.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs.

We observed that staff did not always respond to people's needs in a timely manner. For example the mid-morning drink was not provided until 11.45 am.

Arrangements were in place to ensure people's physical health needs were met. For example, where people had specific issues with their health, such as the need for a specialist feeding regime, the care plans included guidance on how to deliver the care.

We found repositioning charts were completed fully.

Is the service well led?

Staff said that they felt supported and trained to safely do their job. Training plans were in place to ensure staff had the appropriate skills to meet people's needs.

Quality assurance systems were in place and people were listened to. Staff told us they felt able to raise issues and that these were acted upon. We saw satisfaction surveys had been carried out with people who lived at the home and their relatives. We spoke with a relative who told us they felt able to raise issues and if they needed to complain they would know how to do this.

We found gaps in some care records. For example two hospital transfer sheets were not completed which meant if people required hospital admission these would not have been ready for use.

We looked at the statement of purpose and saw it was up to date and reflected the care being provided.

During this inspection there were fifty five people using the service. We spoke directly to three people who used the service, three relatives, two care assistants, the administrator, the deputy manager and the registered manager.

We saw evidence that people were consulted before receiving care. One relative we spoke with told us, “people talk to us about their care and discuss any changes with us.”

We asked people who used the service what they thought of the food that was provided for them, one person told us, “there is nothing to complain about, it’s very good.”

We asked people whether there were enough staff to meet their needs, a relative we spoke with told us, "there always seems to be enough staff around to ask if you need something.”

We saw evidence that staff were trained and supported in their work. One staff member told us, “I feel well trained and supported in my role.”

We looked at the provider’s complaints procedures and spoke to people about the process. A relative we spoke with told us, “I feel confident enough to make a complaint.”

We looked at the provider’s maintenance of records and found that they were adequately maintained and met people’s needs.

During our visit we spoke with people who lived at the home, members of staff, some relatives who were visiting the home, the home owner and the registered manager.

Most of the people we spoke with told us that Drovers Call was a nice place to live and they praised the staff, who they said were helpful. One person told us, “I really like it here, I have my local papers every day and I feel safe.”

People told us that they were asked for their views about the running of the home by the manager and staff and that they felt confident taking any concerns to staff members or the manager direct if needed.

A relative who was visiting the home told us, “We visit regularly. Like any new place they are finding their feet but if we have any issues we know we can speak to the manager direct and it gets sorted out.”

In a recent survey undertaken by the manager one person had said, "All the family are happy with the care provided. The social Therapist has come up with some excellent ideas for social activities."

people told us about things they had done and had planned. One person said, “We had a church service earlier in the week and it was good.”

This inspection took place on 15 December 2016 and was unannounced. Drovers call provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 60 people who require personal and nursing care. At the time of our inspection there were 42 people living at the home. The service is provided across three floors however currently only two floors were used.

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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered safely. We saw that staff obtained people’s consent before providing care to them. The provider did not consistently act in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision. People were encouraged to enjoy a range of social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.