We carried out a review of the data available to us about Foxley Lodge Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Foxley Lodge Residential Care Home, you can give feedback on this service.
Foxley Lodge Residential Care Home is a care home which can support up to twenty-two people in one adapted building. The service specialises in supporting people living with dementia. There were 18 people using the service at the time of this inspection.
People’s experience of using this service and what we found
People were safe at the service. Staff had been trained to safeguard people from abuse and understood how to manage risks to people to keep them safe. There were enough staff to support people. Recruitment checks had been undertaken on staff to make sure they were suitable to support people.
People had a choice of comfortable spaces to spend time in at the service. The provider adapted the premises when needed to meet people’s needs. The premises were clean and tidy. Staff followed current hygiene practice to reduce the risk of infections. Visitors to the service were given information to help them reduce the risk of catching and spreading infection. Health and safety checks of the premises and equipment were carried out at regular intervals.
People’s care and support needs were assessed prior to them using the service. Their care plans set out for staff how these needs should be met. Staff understood people’s needs and how they should be supported with these. They received relevant training to help them to do this. Staff were supported by the home manager to continuously improve their working practices to help people achieve positive outcomes.
Staff were calm, kind and respectful of people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were supported to stay healthy and well. Staff helped people eat and drink enough to meet their needs, to take their prescribed medicines and to manage their healthcare conditions. Staff obtained prompt support for people when they became unwell.
The provider had recently acted to make management changes at service and provider level to ensure the safety and wellbeing of people using the service. People, staff, relatives and the relevant agencies had been notified of these changes.
People and staff’s feedback indicated despite the changes the service had continued to operate as normal and managed well by the home manager. People were satisfied with the quality of care and support they received.
The home manager reviewed accidents, incidents and complaints to identify how the service could improve. People were encouraged to have their say about how the service could improve. The home manager used their feedback along with regular audits and checks, to monitor, review and improve the quality and safety of the support provided.
The service worked with other agencies and healthcare professionals. The provider acted on their recommendations to improve the quality and safety of the service for people.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.
Rating at last inspection
The last rating for this service was good (published 26 October 2017).
Why we inspected
This inspection took place in response to concerns we received about the safety and quality of care and support provided to people and about the management and leadership of the service. A decision was made for us to inspect and examine those risks during the inspection.
We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well-led sections of this full report.
We also looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We found the following examples of good practice.
The provider had appropriate arrangements for all visitors to help prevent the spread of Covid 19. Visitors were required to have their temperatures taken, complete a Covid 19 risk assessment which included screening for symptoms of Covid 19 before being allowed to enter the home. They were required to wear a face covering when visiting, and wash hands before and after mask use.
The provider had appropriate arrangements to test people and staff for Covid 19 and was following government guidance on testing. This ensured that people and staff were tested for Covid 19 so that appropriate action could be taken if any cases were identified.
The provider ensured that all their staff received appropriate training and support to understand and to manage Covid 19. This included best practice for infection control and the use of PPE.
Staff also received appropriate guidance on how to support people with dementia to understand the pandemic and Covid 19. Staff were grouped to work in specified areas of the home including domestic and housekeeping staff.
The provider made appropriate support services available to staff in order to support their mental wellbeing through the pandemic and if they became unwell and when they returned to work.
The provider made very good provision for people using the service to maintain links with family members, relatives and friends. People were supported to have visits from their relatives and friends in sheltered areas of the garden where two metre social distancing was observed. Visits were staggered and restricted to one hour and these areas were cleaned between visits.
Further information is in the detailed findings below.
Although not a breach of the regulations we also found where people lacked capacity to make decisions the reasons for making decisions on people's behalf were not clearly recorded by the provider. We found the environment did not fully meet the needs of people living with dementia.
Foxley Lodge Residential Care Home provides accommodation and personal care for up to 22 older people who are living with varying stages of dementia. There were 22 people using the service at the time of this inspection. The service had a registered manager who was also the provider. 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.
At this inspection we found the provider had taken the action they said they would and now met legal requirements. Arrangements to manage medicines at the service had been improved. Protocols for 'as required' (PRN) medicines had been updated. The provider reviewed each time this medicine was administered to check this had been appropriate for the person. Medicines supplied to the service had been changed by the dispensing pharmacy. This had reduced the risk of medicines not being appropriately administered. People received the medicines prescribed to them. Medicines were stored safely and securely.
There was now enough staff deployed at the service to meet people’s needs. The provider used a dependency tool to assess, review and amend staffing levels as dependency levels at the service changed. We observed staff were present and assisting people when required and answered call bells promptly.
The provider’s arrangements to assess the needs of people prior to admission had been improved and considered how a person’s needs would impact on others at the service to decide whether this would be an appropriate admission to the service.
Records relating to people were now current and well maintained. The provider had reviewed and updated people’s care records and people's support plans were personalised and set out how care and support should be provided based on their preferences and choices. The provider reviewed people’s records to check that the support provided reflected what had been planned and to identify any changes required to the care people received.
Records relating to the management of the service had also been improved. The provider had reviewed and updated the service’s policies and procedures. This meant staff now had access to up to date information and guidance to support their working practices.
Systems to identify any new and emerging risks to people had been revised. The provider reviewed information recorded about accidents and incidents to identify any learning or improvements that were needed to current working practices to improve the quality and safety of the service for people.
The environment had been updated to meet the needs of people living with dementia. The provider had made changes to communal bathrooms and toilets and improved signage to help people orientate and find their way around more easily. The home had been redecorated and new equipment and items had been purchased. An activity co-ordinater had been recruited who had improved the range and quality of activities for people.
People were safe. Staff knew how to protect people from the risk of abuse or harm and followed appropriate guidance to minimise identified risks to people’s health, safety and wellbeing. Staff received relevant training, which included dementia specific courses, and felt well supported by senior staff. The provider maintained robust recruitment checks to assure themselves of staff's suitability and fitness to support people.
The premises and equipment were maintained and serviced to ensure these were safe. The environment was clean and staff followed good practice to ensure risks to people from poor hygiene and cleanliness were minimised. The environment was clear of slip and trip hazards so people could move freely around apart from one area of the ground floor lounge where staff remained vigilant to risks posed to people by a small set of stairs.
People were supported to eat and drink enough to meet their needs and to access healthcare services when needed. Staff encouraged people to participate in activities and events to meet their social and physical needs and reduce risks to them from social isolation.
Staff were caring and treated people with dignity and respect. They ensured people's privacy was maintained particularly when being supported with their personal care needs. People were encouraged to do as much as they could and wanted to do for themselves to retain their independence. Staff were warm and welcoming to visitors to the service.
Staff knew people well and the specific support people required and how each person communicated their choices about what they wanted. People were prompted to make choices and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.
People, their representatives and staff were encouraged to provide feedback about their experiences and suggestions for how the service could be improved. The provider maintained arrangements to deal with people's complaints appropriately if these should arise.
The provider used their quality monitoring systems to check that improvements that had been made could be sustained and maintained. Audits and checks of other aspects of the service continued to be made by the provider to assure themselves of the quality and safety of the service. The provider had contracted an external organisation to audit different aspects of the service to offer robust challenge around existing working practices and procedures.
The provider was working proactively with external organisations to improve the quality of the service. They used best practice to improve the quality of support provided to people living with dementia.
Foxley Lodge is registered to provide accommodation and personal care for up to 22 older people who are living with varying stages of dementia. Accommodation is arranged over three floors with access via a passenger lift. 18 of the 22 bedrooms are en-suite. On the ground floor, communal areas include two separate lounges, a kitchen, dining room, bathroom and toilet facilities and an office. There is an enclosed rear garden with paved area for people to access. There were 20 people using the service at the time of our inspection.
The service had a registered manager who was also one of the owners. 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 did not follow consistent safe practice for the recording and safe administration of people’s medicines. Medicines documentation was not always completed appropriately and there were not always clear instructions for how medicines should be administered. This meant that people may not receive their medicines safely.
The provider did not ensure appropriate skilled and experienced staff were deployed at the home to meet the various needs of people who used the service. There was not enough staff on duty to provide activities or respond to people's needs in a timely way.
Staff were familiar with people's needs, and received regular training to keep their knowledge and practice up to date. We were not assured however that staff had the skills and expertise to support the specialist needs of the people using the service.
The arrangements to monitor service provision did not always identify shortfalls and ensure that people were well cared for and safe. The provider’s systems were not used effectively to keep checks on standards, develop the service and make improvements.
People using this service did not always experience responsive care and support that was appropriate to their needs. Care plans did not always record all the information staff needed to care for and support people effectively. We also found that records relating to staff and the management of the service were not up to date or consistently maintained. Incidents and accidents involving people who used the service were not always reviewed or investigated to check that appropriate action had been taken. In addition, people’s care and monitoring records were not consistently maintained to accurately reflect the care and support provided to people.
Where people lacked capacity to make decisions, staff were aware of how to support these people in line with the law although the reasons for making decisions on people’s behalf were not clearly recorded. Appropriate applications had been made to the supervisory body to restrict people’s liberty where required.
We found that areas within Foxley Lodge could be decorated and equipped more suitably for people living with dementia. The provider agreed to look at ways to improve the environment to provide more engagement and stimulation.
People had positive relationships with the staff who they described as caring and helpful. Staff respected people’s privacy and treated individuals with kindness and patience. Staff made sure people’s dignity was upheld and their rights protected. Staff were knowledgeable about the risks of abuse and the procedures for reporting any concerns.
People were supported to maintain good health and had access to healthcare services when they needed them. The service had made timely referrals for health and social care support when they identified concerns in people’s wellbeing. People were encouraged and supported to eat a nutritional diet that met their needs and recognised their choices.
The registered manager was aware of when to send us a statutory notification to tell us about important events which they are required to do by law.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to managing risk for people using the service, staffing levels, the systems for monitoring the quality of service provision and record keeping. You can see what action we told the provider to take at the back of the full version of this report.
We have made recommendations about staff training on the subjects of dementia and person centred care. We have also made recommendations about the environment and some aspects of record keeping under the Mental Capacity Act 2005.
Foxley Lodge Residential Care Home provides residential care for people living with different stages of dementia. During the time of this inspection it was providing care for twenty people.
The home is arranged over three floors. On the ground floor, there are two separate lounges, a kitchen, dining room, and the manager’s office. There is a large outdoor space for people to spend time in. Bedrooms are arranged over all three floors and eighteen out of the twenty two bedrooms are en-suite. There was a registered manager in post at the time of our inspection.
People told us they were happy at the home and that they felt safe. Staff had completed safeguarding training and were aware of the procedures to follow if they had any safeguarding concerns.
The premises and equipment were managed appropriately. The home was well maintained and equipment was serviced regularly. There was a working lift and stair lift at the home. Service records for fire alarm, call bells, smoke detectors and other equipment were seen.
The provider was in the process of reviewing the care plans and risk assessments. Where they had been updated, we saw that the care records were individual to people using the service and were person centred.
People were supported to eat if required. They were given enough time to finish their meals and were not hurried.
We observed interaction between staff and people using the service during lunch and during some activities. Staff tried to involve people during activities which people enjoyed.
We looked at training and supervision records for staff. We saw that staff had attended mandatory and more specialist training based on the needs of the people using the service. Supervisions were carried out on a regular basis by senior staff.
We found that there were sufficient numbers of staff with the right skills and experience to meet people’s needs. Staff that we spoke with felt staffing levels at the home were sufficient. People who used the service told us there was always someone available to help.
We spoke with people who used the service. Comments included, “they look after us quite well and have a chat sometimes” and “there has been big changes and improvements.” Some people were not able to express their views and so we observed the care provided. We spoke with two relatives and a district nurse who visited that day and six members of staff. A relative said they “were very pleased with the care. The staff are very kind.”
We found that the provider/registered manager and staff had taken action to address the compliance actions made at the last inspection. There were improved arrangements to ensure that people were supported with decision making and that their views were considered in the planning of care. Written care plans and records had been reviewed and personalised and gave a clearer picture of the support required. Safeguarding policies had been updated, procedures had been followed and staff were aware of what to do if they had concerns. Effective quality assurance systems were now in place.
We also found there were adequate procedures in place for infection control. Staff were provided with suitable training to carry out their work effectively.
The majority of people living at Foxley Lodge do not have the capacity to fully share their views regarding their care. In order to make judgements about people's care experiences, we observed care practices; interactions with staff and tracked six people's records of care. Case tracking means we looked in detail at the care people receive.
Staff respected people's routines and preferences and ensured their dignity when providing personal care. People we spoke to commented that they found the staff to be “kind” and “always cheerful”.
Comments from visitors included, “the staff are exemplary and treat people with respect. They know everyone’s name” and “the staff are very caring.”
We found that people's care records were not always appropriately maintained, reviewed and monitored. People had not been fully involved in making decisions about their care. We also found that safeguarding incidents were not always correctly identified and reported appropriately. This meant that the service had not followed safeguarding procedures and did not give assurance that people were as protected as they should be.
There were insufficient systems in place to identify and analyse incidents that resulted in or had the potential to result in harm to people using the service.