Drummond Court 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 care provided, and both were looked at during this inspection. Drummond Court provides accommodation and personal care for up to 36 people who have learning disabilities and/or autistic spectrum disorder. At the time of our inspection there were 28 people using the service.

This unannounced inspection took place on 14 and 15 November 2017.

There were two registered managers in post when we inspected the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We brought forward this inspection due to concerns of which we had become aware that had been reported to the local authority safeguarding service. These concerns included a person not having an appropriate lunch prepared for them when away from the service for the day, people having ill- fitting or were wearing other people’s clothes and looking unkempt and a two-way communication book used by Drummond Court staff and another service not being completed or sent with the person when attending another service. We spoke with the local authority safeguarding team and learnt that these concerns had not been substantiated by them and had been closed.

The overall rating of this service was Requires Improvement at our last inspection of 23 and 26 May 2016. The key questions Safe and Effective were rated as Requires Improvement. Care, Responsive and Well-led were rated as Good.

At this inspection we found the service had improved and is now rated ‘Good’ overall. There had been improvements made in the service. This included much clearer and robust moving and handling risk assessments being in place and staff knowing how to support people with regard to their moving and handling needs. Monitoring of medicine stocks had been increased and staff were knowledgeable about people’s medicines and why they had been prescribed. Staff were aware of people’s assessed needs including those people requiring support to manage their diabetes.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The staff demonstrated a clear understanding of the actions they would take if they suspected or witnessed any concerns about people’s safety. Risks were assessed and management plans were in place to minimise the risk to people’s safety while respecting their right to pursue interests of their choice. Medicines were managed safely and sufficient numbers of trained staff were deployed to meet people’s needs.

Staff had received infection control training and used this information for the storage of food and cleanliness of the accommodation.

The registered managers learned from incidents or accidents within the service and made the necessary improvements. They shared this information with the staff through supervision and staff meetings.

Staff were provided with a wide range of training appropriate to the various needs of the people living at the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were provided with a healthy and well balanced diet and were encouraged to take part in the preparation of meals.

Other professionals worked with staff so that people had access to healthcare services a

The inspection took place on 23 and 26 May 2016 and was unannounced.

The service provides care and support for up to 36 people who have learning disabilities and/or autistic spectrum disorder. At the time of our inspection there were 32 people using the service.

The service did not have a registered manager in place but an application had been made and was awaiting consideration by the commission. 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 trained in safeguarding people from abuse and systems were in place to protect people from abuse. Staff understood their responsibilities to report any safeguarding concerns they may have and were confident they had the skills to do this.

Risks to people and staff were assessed and action taken to minimise these risks. People were encouraged to remain as independent as possible and any specific risks related to this were assessed. However we observed one person to be at risk with regard to their moving and handling and the service had not taken a proactive approach to this.

Medicines management had improved considerably since our last inspection and was mostly good. We did, however, find some stocktaking discrepancies and one pain relieving medicine which had been dispensed but did not appear in the records. Therefore medicines could be more safely managed. We have made a recommendation about this aspect of medicines management.

Staffing levels meant that people were safe and increased staffing had already had a beneficial impact on people’s ability to go out. Recruitment procedures were designed to ensure that staff were suitable for this type of work and checks were carried out before people started work to make sure they were safe to work in this setting. New staff were able to shadow more experienced staff and a robust induction was provided.

Training was provided for staff to help them carry out their roles and increase their knowledge of the healthcare conditions of the people they were supporting and caring for. Staff were supported by the managers through supervision and appraisal systems.

People gave their consent before care and treatment was provided. Staff had been provided with training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. People’s capacity to give consent had been assessed and decisions had been taken in line with their best interests. There was a good understanding of processes related to DoLS.

People were supported with their eating and drinking needs and people were fully involved in shopping and cooking. Staff helped people to maintain good health by supporting them with their day to day physical and mental healthcare needs, although support plans for people with diabetes were not clear and staff were confused about their responsibilities.

Staff were caring and treated people respectfully making sure their dignity was maintained. Staff were positive about the job they did and enjoyed the relationships they had built with the people they were supporting and caring for. The atmosphere was of a positive and friendly service.

People, and their relatives, were involved in planning and reviewing their care and were encouraged to provide feedback on the service. Care was individualised and subject to on-going review and care plans identified people’s particular preferences and choices. People were supported to follow their own

We previously carried out an unannounced comprehensive inspection of this service on 26 and 28 August 2015 and found that the service was Inadequate in the two key areas Safe and Well Led. The overall rating for the service was Inadequate. This means that the service was placed into ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

In addition to placing the service in ‘special measures’ we also served warning notices as the service was in breach of regulations 13 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The regulation 13 warning notice was issued because the service had failed to protect people from the risk of financial abuse and staff had not responded appropriately to a possible safeguarding issue. These issues had also been identified at the previous inspection which was carried out on 10 December 2014. This meant that the service had not made the required improvements over a sustained period of time. The regulation 18 warning notice was issued because the service failed to ensure there were enough suitably qualified, competent, skilled and experienced staff on duty and had failed to provide them with the training and support they needed. The warning notices required the service to make the necessary improvements by 15 December 2015.

We undertook this focused inspection on 14 January 2016 to ensure that the service had made the required improvements. The inspection was unannounced. This report only covers our findings in relation to safeguarding and staffing issues and does not affect the overall rating of the service which remains Inadequate. The service will remain in special measures until we carry out our next comprehensive inspection. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Royal Mencap Society Drummond Court on our website at www.cqc.org.uk.

Drummond Court provides care and support for people with learning disabilities who live in bungalows and flats on the same site. Some people are quite independent while others have significant care needs and require more support and care. The service is registered to provide care for 36 people and at the time of our inspection 33 people were resident.

The service had no registered manager in place. The most recent registered manager had left the service in February 2015 and the manager appointed to replace them had also left the service without becoming registered. 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.

This report specifically focuses on the key area of Safe with regard to how staffing and safeguarding matters were managed.

Staff reported that there was now a more consistent staffing pattern. Some temporarily deployed staff now had substantive posts and the service had recruited new staff. The regional manager, who had been redeployed to support the service, was also to continue to have line management responsibility for the service which provided further continuity. The vacant hours had reduced and those that remained were mostly being covered by regular agency staff who knew people well.

Staff told us they felt more supported and most staff were receiving regular supervision, although some concerns remained in one area of the service. Staff appreciated the fact that they were less likely to be asked to cover shifts in parts of the service they were not f

During our inspection we spoke with five people who used the service. Some of the people were unable to communicate with us verbally but we observed their care and support. We spoke with two people's relatives, eight members of the care staff and the registered manager. We also looked at the care records for four people. Other records we reviewed included staff files and quality and monitoring records. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is the summary of what we found:

Is the service safe?

Care records were generally updated to ensure that people received the care they needed to keep them safe. We did find some records which were not completed appropriately and contained conflicting information which could have put some people at risk.

The service worked with other healthcare professionals to help meet people’s healthcare needs.

We saw that regular checks were carried out on equipment and systems, such as the fire alarm system, to make sure they were safe to use. We were concerned that advice given at the last two fire system checks had not been followed up and we have referred our concerns to the fire service.

We looked at staffing rotas and found that there were enough trained and experienced staff on duty to meet people’s needs and ensure their safety. We saw that new staff and agency staff had received an induction to ensure they were informed about how to meet the needs of the people who used the service and keep them safe.

We found that the service was fully aware of their responsibilities under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and that staff had received training. We saw that the service was considering making a DoLS application for one person.

Is the service effective?

People’s care and support needs were assessed in consultation with either the person themselves or their relative. People’s care plans reflected their care and support needs and the service worked with external healthcare professionals to meet them.

We were concerned that some people's plans contained conflicting information which might have made it difficult for staff to support them effectively and safely.

People who used the service told us that they were happy and we observed that most people attended a variety of activities and were involved in their local community if they chose to be.

We were concerned that some people who needed a higher level of support did not have sufficient opportunities for meaningful activity both at the service and in the community. One relative of a person who used the service was very concerned about the lack of activity and occupation provided.

We saw that people were supported to increase their independent living skills and some people were planning to live more independently in the future.

Is the service caring?

People were supported by staff who were kind, caring and respectful. We observed staff engaging positively with people and encouraging them to increase their independent living skills.

People who used the service told us they were happy with the care provided and spoke positively about the staff. One relative of a person who used the service told us, “The staff are on the ball. I have no worries there. Whenever I come [my relative] is lovely and clean and well looked after”.

Is the service responsive?

People's care records showed that where concerns about an individual’s wellbeing had been identified, staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance promptly from other health care professionals when one person’s health had declined recently.

Protocols and care plans had been put in place to support one person whose behaviour could be challenging to staff and other people who used the service. The service had secured additional funding to pay for one to one staffing for this person.

People’s preferences and choices had been recorded in their care plans and we observed that generally care and support was delivered in accordance with people’s wishes.

We were concerned that people living in one particular bungalow were not always given the opportunity to make choices about how they spent their time.

Is the service well led?

We saw that considerable improvements had been made by the registered manager since the last inspection. The service had a quality assurance system in place but the issues we identified, which related to some poor record keeping and lack of meaningful activity for some people, has not been identified.

We saw that staff received the training they needed to carry out their roles and that they were supervised and supported by the manager.

The service sought the views of the people who lived there as well as those of relatives, other professionals and staff. Issues raised as a result of surveys sent out to people were put into an action plan to make sure improvements were put in place.

The purpose of this inspection was to check that improvements had been made following our last inspection 24 June 2013 when we found that improvement was required across several areas where the provider was not meeting essential standards of quality and safety. We therefore made compliance actions which required the provider to take action to address the concerns identified. The provider sent us an action plan where Royal Mencap told us the actions they would be taking to address the concerns identified within a reasonable timeframe. During our inspection 25 November 2013 we found evidence of some improvement. However, further work is required in order to protect and ensure that people's care, treatment and support needs are being met.

During our inspection we spoke with seven people who used the service. People we spoke with had limited communication skills but were able to demonstrate that overall they were satisfied with the support they received. One person told us, “Things are getting better.” Another told us, “Staff are very good to me. I like it here.” However, people also told us they were not being consulted and communicated with regarding changes to the day services provided on site and the decision made to charge people for transport services.

We saw that people were protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines.

We looked at the care records in detail of four people where recent safeguarding concerns had been received by the Care Quality Commission (CQC). We were satisfied that appropriate actions had been taken to investigate and manage the concerns.

We looked at the care records in total of seven people who used the service. We saw that further work was needed to ensure that records were regularly updated to reflect the current needs of people who used the service.

We inspected Drummond Court on 16 January 2013 and found that improvement was required across several areas. We therefore made 'compliance actions' which required the provider to create an action plan of how they were going to address the issues within a reasonable time frame. We received this action plan and Royal Mencap stated that they expected to be compliant by 31 May 2013. Two inspectors returned to re-inspect the service on 24 June 2013 and we found evidence of improvement. However, sustained effort is required in order to ensure that all people's needs are being met and to ensure that staff have the capacity and competencies to provide a good level of care.

We inspected this service to assess compliance with Outcome 9 Medicines Management. People we spoke to said they were pleased with the support staff gave them with medicines. Managers told us there was an extensive programme in place for staff training and assessment of their competence in medicine management. We found appropriate arrangements in place for the recording, handling and safe administration of medicines, however, for a person managing some of their own medicines more frequent risk assessment of this and provision for the safe storage of their medicines was needed together with safe storage of medicines requiring refrigeration and the specialised storage and recording of controlled drugs.

We spoke with twelve people using the service and most were able to confirm to us that they were safe and happy. Some people were unable to talk to us and so we spoke with their key worker, other healthcare professionals and relatives where possible to establish their views of the service. We found that some healthcare professionals and relatives had concerns about staffing levels on three units (especially at night). Some told us that care support plans were not always complete and up to date and that the needs of some people with specific medical conditions were not always met.

We found that some people were supported to take part in a wide range of activities. However people with more complex needs did not benefit from as much interaction and stimulation. A recent staffing re-organisation meant that significant numbers of staff were leaving the service. This posed a risk to continuity of service because a full complement of replacement staff had not yet been recruited. Some feedback had been sought from relatives and residents, but there was scope to seek out the views of other healthcare professionals and to ensure that all feedback is acted upon in order to make service improvements. Internal audit work had taken place but some action was still outstanding.

People living in Drummond Court received different levels of support and care depending on their needs. Some were independent while others had profound learning and physical disabilities.

The accommodation was also varied with people living in shared houses and flats on the same site. Where possible, we observed the care provided and interaction with staff and people using the service.

We met and spoke with five people who used the service. One person told us “It’s nice here the support workers are very kind and help me to look after myself.”

People told us they experienced good care and their healthcare needs were met. One person said about the support workers “They look after me and treat me well. I like everybody and am happy at the home.”

We asked people if they were not happy about their care or treatment what they would do and people told us they would speak to their support workers or the registered manager. One person told us “I can talk to the manager, I have known them a long time and they are very supportive and trustworthy.”

People we spoke with were aware of the refurbishment work that was underway in the service and the improvements that had been made. One person told us “They (provider) have done up some of the units, getting new furniture in and decorating some of the rooms. It makes it look nice and smart, much more homely. I like it”.

This inspection took place on 26 and 28 August 2015 and was unannounced.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

The service provides care and support for people with learning disabilities who live in bungalows and flats on the same site. Some people are quite independent while others have significant care needs and require more support and care. The service is registered to provide care for 36 people and at the time of our inspection 33 people were resident.

The service had no registered manager in place. The last registered manager had left the service in February 2015 and the manager appointed to replace them has now also left the service without becoming registered. 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 has been in breach of a number of regulations over the last three years. When we last inspected the service on 3 and10 December 2014 we found there had been six breaches of regulation. The provider had supplied us with a detailed action plan outlining how they would improve the service and meet the regulations within an agreed timescale.

We met with the provider in January 2015 and were given assurances that the required actions would be put into place. The provider stated that all required actions would be in place and they would be operating in line with the regulations by the end of July 2015. We found that this was not the case at this inspection. Extremely high numbers of staff vacancies over the last year have not been successfully addressed and we have seen an increase in safeguarding concerns and alerts from people who used the service, relatives, professionals connected with the service and members of the public over this period. Many of these related to inconsistent or short staffing and the fact that staff were not familiar with people’s needs.

Throughout this inspection we found evidence of both good and poor practice. Previous inspections had identified that certain units needed to make considerable improvements to keep people safe and meet their needs. We found that a lot of improvements had been made in these specific areas but other areas of the service now remained the focus of our concerns. Therefore, whilst we acknowledged the hard work that had gone into improving previously failing areas, we were concerned to find similar issues in other parts of the service at this inspection.

We found that the service did not always respond promptly to allegations of abuse and systems designed to protect people from financial abuse were not always adhered to.

Risk assessment was both good and poor in different parts of the service. Some risks had not been comprehensively assessed and left people at risk. We also found risks associated with the management of medicines and errors, related to the administration of medicines, were high and had not reduced significantly since our last inspection.

Staff received most of the training they needed to carry out their roles effectively but training around specific healthcare conditions was not in place for everyone. Staff understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) was not good. The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. People’s consent had not always been established in line with the MCA. The service was operating in accordance with DoLS.

There was a mixed picture with regard to supporting people with their eating and drinking with some excellent practice in some units in the service and concerns about practice in others.

Previously we had had a number of concerns about people’s access to healthcare appointments. This was much improved across the service but we were concerned about the management of some people’s epilepsy.

Most staff were caring and compassionate and supported people sensitively. Others demonstrated a less caring manner with their language and actions.

Opportunities for people to follow their own interests and hobbies had improved since our last inspection but staffing levels meant people did not have enough to do and did not go out as often as they wanted to.

Complaints were not managed well and formal complaints the service had received had not all been responded to promptly and resolved to people’s satisfaction.

Ultimately the service has not been well led over a significant period. Several changes of management and a lack of a consistent strategy to deal with the serious issues facing the service have led some people who used the service, relatives and professionals to lose confidence in the service. Very recent management changes have made significant improvements but the staffing strategy involves redeploying staff on a temporary basis which is not a long term strategy. Whilst it is the case that additional permanent staff have been recruited, a number of staff expressed to us that they were intending to leave and morale remained low with some key members of staff. Support and guidance for staff, particularly new staff, had been poor during the last few months and demonstrated the lack of oversight the provider had of the issues facing staff and of risks posed to the people who used the service.

The leadership of the temporarily redeployed regional operations manager had begun to address longstanding issues at the service and people who used the service and staff were positive about the impact this had had in a very short time. Our concern, as a regulator, is about how the provider will ensure that this is sustained.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.