This inspection site visit took place on 9 November 2017 and was unannounced.

Druid Stoke is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is run from two buildings located next to each other. One building provides nursing care and the other provides residential support.

There was a registered manager for the service .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.

Following the last inspection in October 2016, we asked the provider to complete an action plan to show what they would do to improve the outcomes in safety, effectiveness and being well led to at least good. We found that the provider had taken action in these areas and met the requirements of the action plan.

Where people had the capacity they were now well supported in making decisions about how they wanted to being cared for. There were now effective systems in place that helped ensure staff obtain consent to care and treatment in line with legislation and guidance. When people did not have the capacity to consent, their care needs were assessed in line with the Mental Capacity Act 2005 (MCA). Staff had completed MCA and knew about supporting people to have the right to make decisions in their daily life as well as to take risks. Staff also knew how to act in someone’s best interests.

Staff recruitment procedures had been ‘tightened up ‘and improved. There were systems in place to reduce the likelihood of unsafe and unsuitable staff being taken on at the home.

There were now effective quality checking systems being used to monitor the service and overall experiences for people who lived at the home. This helped ensure people always received care that was personalised to their needs. Quality audits now picked up where improvements were needed and actions were then implemented to address the areas concerned.

People told us they that they felt safe and secure at the home and they confirmed for us that staff were kind and treated them in a respectful way. When risks to people were identified suitable actions were implemented to reduce the risks of people being harmed in anyway. The risks of abuse to people were further minimised as staff were competent in their understanding of abuse and how to keep people safe. The team were trained to know how to report concerns without delay.

Staff provided people with care that was safe as there were enough suitably qualified staff. Some people told us they felt at times there should be more staff on duty. Some people said staff sometimes seemed rushed and did not have as long to talk with them as they would like. Overall our evidence showed that the numbers and skill mix of staff deployed at any time of the day or night meant peoples’ needs were met in a timely manner.

People told us how much they liked the programme of regular one to one and group activities taking place in the home. Some people on the nursing side of the home felt that they would like more entertainers to perform there and, more one to one time with the activities coordinator The registered manager had identified this feedback already from their own consultations with people at the home . They were taking actions to review the activities that took place for people who lived on the nursing side of the home.

People were provided with a varied diet that suited their needs. People spoke highly of the menus and told us that they liked the food and also that they were offered choices at each mealtime.

People who lived at the home and the staff had built up p

During August and September 2016, we received a number of concerns about the care provision at Druid Stoke Care Home. This information of concern was received from people, friends and family, and from health and social care professionals. As a result of this information, we undertook an unannounced inspection of Druid Stoke Care Home on 4 and 7 October 2016.

When the service was last inspected in April 2016 there was one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified. We found staffing levels were not sufficient to meet people needs safely and in a person centred way. The provider wrote to us in July 2016 and told us how they would achieve compliance with this regulation and this was followed up as part of this inspection. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Druid Stoke Care Home, on our website at www.cqc.org.uk

Druid Stoke Care Home provides personal and nursing care for up to 60 older people. The home is run from two buildings on the same site. One building provides residential care and the other nursing care. At the time of our inspection there were 44 people living at the home.

A registered manager was in post at the time of our inspection. 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 home is run.

The home was not always safe as we found recruitment procedures were not robust. This meant that people unsuitable for the role could be employed. When an accident or incident occurred there was a procedure in place for reporting. However, we found this was not always used and therefore incidents may not get investigated thoroughly. Staffing levels had improved since out last inspection in April 2016. However, there was mixed feedback in people’s experiences of staffing levels.

Medicines were stored and administered safely by trained and competent staff. There was clear information and guidance in place for staff and regular audits and checks of medicines were completed. The home was clean and well maintained. Effective checks took place to ensure the environment and equipment was safe. People did not always receive effective care in supporting their healthcare needs.

The registered manager was aware of their responsibilities in regards to (DoLS). DoLS is a framework to assess if the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm is required. However, information recorded about DoLS was not always clear and meant staff did not have a clear understanding of who had an authorised DoLS.

People and relatives told us that staff were kind and caring. We observed positive interactions and relationships between staff and people living at the home. People told us staff respected their privacy and maintained their dignity.

People enjoyed the activities on offer at the home. People were involved with how the home was run through regular meetings, which sought people’s views and opinions. We saw that the home responded to the feedback received. Care plans gave information about people’s background and personal preferences. Staff were knowledgeable about how people liked their care and support delivered. We observed staff being responsive to people’s daily support needs.

The home was not always well-led. Notifications had not always been sent to the Commission, which is a legal requirement. Audits were in place to assess and monitor the quality of care. Whilst some were effective they were not always consistently completed. Staff could contribute their feedback and ideas through meetings. People and relatives had access to the home’s complaint procedure. However, we fo

The inspection took place on 08 April 2016 and was unannounced. The service was last fully inspected in July 2014 when there were breaches of the legal requirements of the legislation that was in place at that time.

Druid Stoke Residential and Nursing Home is registered to provide personal and nursing care for up to 60 people. The service is run from two buildings on the same site. On the day of the visit, there were 37 people at the home.

There was no registered manager although a new manager had been appointed and had been working at the home for the last four months. They have put in an application to be registered with us. 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.

There were not always enough staff on duty to provide individual care and support to people and to keep them safe. Specifically the numbers of staff providing care and support on the nursing side of the home did not meet people's full range of needs at all times. The new manager and the senior manager told us they had identified this as an area for improvement. An action plan was already in place to address a shortage of suitable staff.

Some care plans did not fully show how to meet people’s range of care and nursing needs. This meant there was a risk that those people whose care plans were not complete may not have their needs properly met.

People told us they felt safe there and that staff treated them properly. They said that staff were never rude and were always courteous. Where risks to people were identified suitable actions were put in place to reduce the risk of people being harmed when receiving care. The risks of abuse to people were minimised as staff had been trained to understand what it was and how to report concerns.

There were positive and caring relationships between staff and people who lived in the home and this extended to relatives.

Where possible, people were involved in making decisions about how they were looked after. The provider had effective systems in place that helped ensure that staff obtained consent to care and treatment in line with legislation and guidance. When people did not have capacity to consent to their care needs were assessed in line with Mental Capacity Act 2005. Staff had completed Mental Capacity Act training. They knew about consent, people’s rights to take risks and how to act in someone’s best interests.

People told us that they were happy with the food and told us they were offered choices at each mealtimes. People were provided with a varied diet that suited their needs. There were regular one to one and group activities taking place in the home. People told us they enjoyed the entertainers who performed at the home regularly.

People were assisted by staff that were trained and developed in their work to improve and develop their skills. Nurses were able to go on training courses to help them know how to provide nursing care and clinical care based on current practice.

The new acting manager was providing clear leadership and had identified areas that needed improvement. The staff team told us they now felt well supported. The manager spoke positively about the challenges of their new role. Quality audits were effective and had identified the shortfalls in staffing levels on the nursing side of the home and the shortfalls in some care records. Actions were in place to address these areas.

You can see what action we have taken at the back of the report

The purpose of this inspection was to follow up previous non-compliance where we identified serious failings in the home. Below is a summary of what we found. The summary is based on our observations during the inspection, seeking experience and views from people who used the service, their relatives, the staff supporting them and from looking at records. The inspection team consisted of two inspectors and an expert by experience. We spoke with 12 people using the service, two relatives of people and 10 staff.

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

Is the service safe?

We looked at one aspect of safety to follow up our concerns about insufficient numbers of suitably qualified, skilled and experienced staff from our last visit. Peoples dependency levels were risk assessed to calculate adequate staffing levels. Additional staff had been employed and unplanned absences were covered to ensure that safe staffing levels were maintained. People were assisted and supervised during mealtimes as they required. People and their relatives told us there was an improvement in the number of staff available including during meal times.

People were safe because staff were trained and supported to work on the nursing unit and the residential unit. New systems in place to support staff had improved the care and welfare for people who required frequent position changes for skin care. People told us how quickly staff responded to their needs when they rang their bell, “Staff are very good, very quick coming to me and there are enough staff” and “They [staff] come straight away”.

At the time of our inspection 35 people were living in Druid Stoke Residential and Nursing Home. During our inspection we spoke with people living in the home, staff, and the registered manager.

Refurbishment of the home was being undertaken at the time of our inspection. People living in the home were involved in the planning, informed fully of the timeframes and advised of any adverse effects on the service during this time. During our inspection we found the refurbishment was being managed effectively and people told us it didn’t affect them on a day to day basis.

We examined the care records for people living in the home and observed how staff interacted and supported people in communal areas.

Overall people’s comments were positive. People told us they were happy with the care and support that they received and knew how to make a complaint should the need arise. People’s comments included; “the food is good”. “They are lovely here, very kind people”. “Staff are ok but very busy at times and a little business like”. “Can’t fault one bit, everything is tickety boo”.

Staff we spoke with told us people received a high standard of care. Staff felt supported by the management team to be able to fulfil their roles effectively. One member of staff said “I wouldn’t want to work anywhere else”.

The provider had effective systems in place to monitor the effectiveness of the service that was provided.

Druid stoke nursing and residential home is on one site but set into two separate nursing and residential care units. This inspection report covers both the units as a whole.

At the time of our visit, there were forty three people living in the home. We spoke with seven people who use the service, six staff members, two relatives and one visiting professional, to gain an understanding of the service that was being provided.

We received a number of positive comments from people that included; “I like it here” and “it’s nice”, “I feel grateful to be in such a lovely place, of course its not home, but they do try to make it as nice as possible”. Another person told us “the staff are lovely, very busy but lovely. Sometimes I wish they had more time to sit and just talk”.

One visiting professional told us the communication was excellent within the staff team and staff would ring to inform them of any problems.

When we asked people if they felt able to talk to staff if they were unhappy, people answered that they would. People we spoke with told us they felt safe and were treated well by staff lat Druid Stoke.

We found that people were supported in a clean and hygienic environment and that there were policies and procedures in place, to support staff.

People told us how well supported they were by staff and about life at Druid Stoke. We were told “I think It’s very good the manager has very high standards”. “It's very good here and some of the staff are excellent”. “The staff are good they are kind and they listen to you”. “The staff are very kind sometimes they seem a bit short staffed”.

People were seen to be effectively supported by staff with their range of nursing and personal care needs. We saw that care plans supported care practises with information to guide staff to give people the care they needed. However we saw that when a pressure pad alarm was used to help to maintain the safety of a person in their bedroom, an assessment of their mental capacity had not been carried out. Using pressure pad alarms are legally defined as being a form of restraint under the Mental Capacity Act. This means an assessment of people’s mental capacity to make informed decisions needs to be carried out when considering using the use of this equipment to help to maintain someone’s safety.

People felt safe and properly treated living at Druid Stoke. We saw systems in place to ensure staff were competent with the information they needed available to guide them to keep people safe in the home.

People were cared for by a staff team who had attended regular training and learning opportunities on subjects relevant to their needs. People were cared for by staff who had an understanding and awareness of their range of nursing and personal care needs.

We saw that people were asked what they thought of the care and support they received at Druid Stoke. There were effective methods used to check, monitor and improve even further the quality of the service people received. We saw systems to review and learn from critical incidents and occurrences that had impacted on people's health and wellbeing.

Druid Stoke Nursing and Residential home is registered to provide personal and nursing care for up to 60 people. The service is run from two separate buildings on the same site’ one residential unit and one nursing unit. There were 22 people resident in the nursing unit and 21 people resident in the residential unit at the time of our inspection.

We had received information of concern which prompted us to carry out a responsive inspection of the home. The inspection was undertaken by two CQC inspectors and an expert by experience over a period of three days. This included an early morning visit on the first day of inspection (5:15am). During our inspection we looked at the records relating to people receiving care in the home. We spoke with the majority of care staff on duty, nurses, the registered manager and deputy manager. We also spoke with a minimum of 16 people living in the home, five relatives and a visiting doctor.

In addition to this we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us to understand the experience of people who could not talk to us.

Following the inspection we considered all of the evidence we had gathered under the standards we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service effective?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:-

Is the service safe?

People told us they felt safe. Although safeguarding procedures were robust they had not been implemented effectively by the registered manager and staff did no fully understand their role in safeguarding the people they supported. The registered manager had also failed to raise safeguarding alerts with the local safeguarding authority when serious injuries or abuse allegations had occurred.

There was no effective system in place to make sure that registered manager and staff learnt from events such as concerns, whistleblowing and investigations. This increased the risk of harm to people and fails to ensure that lessons are learned from mistakes.

We found that people were at risk of being unsafe because their risk assessments lacked consideration of all contributing factors to their safety; personal risk, environmental risk and staffing levels.

There were not sufficient staff on duty to safely meet peoples’ needs. The planned numbers of staff on duty did not take account of the varying needs of people or this skills and experience of the staff.

The home was safe, clean and hygienic. However we did find examples of poor infection control by staff and in the bathrooms and laundry of the home. This was putting people at risk of harm.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that a DoLS application had been made in the week prior to the inspection and it had been applied by the relevant authority. There is however a requirement to submit a statutory notification to the CQC once a decision has been reached in respect of a DoLS application. We found that the required notification had not been submitted and the registered manager was not aware of the need to do so.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were kind and gave encouragement when supporting people. People commented: “they treat me kindly” and “the staff are very kind”.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. There were some shortfalls, and concerns had been raised by relatives. The registered manager was unable to tell us what actions they have taken to address these shortfalls. People were at risk of not having their concerns and needs properly taken into account.

People’s preferences, interests, aspirations and diverse needs had not always been recorded. Because of this care and support could not always be provided in accordance with people’s wishes.

Is the service effective?

People’s health and care needs were assessed with them however people were not aware of what was in their care plans. Specialist dietary needs were not always assessed and included. Some of the care plans had not been reviewed regularly. Care plans were therefore not able to support staff consistently to meet people’s needs.

People’s mobility and other needs were not always taken into account, enabling people to move around freely and safely.

Is the service responsive?

People’s needs had been assessed before they moved into the home. People told us that the pre admission assessments had taken place.

Records did not always confirm that 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 did not have access to activities that were important to them. The service was not fully informed about the person’s needs and therefore could not respond appropriately.

We saw that the staff had involved other healthcare professionals when required. For example, community nurses and community mental health teams were involved in people’s care and support. We saw from people’s records that the staff had attended multi agency meetings about people at times.

Is the service well led?

The majority of the staff we spoke with did not have a good understanding of the safeguarding and whistleblowing policies. All of the staff said that if they witnessed poor practice they would report their concerns to the registered manager or within the provider management team. When asked the majority of staff were not aware of external organisations they could contact to report matters to.

Some aspects of the service were not well led as action had not been taken to rectify shortfalls. The service has a quality assurance system, records seen by us showed that not all of the shortfalls identified had been addressed. The system did not systematically ensure that staff feedback was properly taken into account.