We carried out a review of the data available to us about Foxley Lane 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 Lane, you can give feedback on this service.
About the service
Foxley Lane is a residential care home providing personal care to 8 people at the time of the inspection. The service can support up to 8 people.
People’s experience of using this service and what we found
Right Support
The provider had acted to make improvements that were required after our last inspection. People now received care and support in a safer, cleaner, well equipped and well-maintained environment that met their sensory and physical needs. People received better support with their medicines to achieve the best possible health outcome. Staff supported people to have the maximum possible choice, control and independence and they had control over their own lives.
Right Care
People now received kinder, more compassionate care from staff and staff promoted equality and diversity in their support for people. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The home manager made sure there were enough appropriately skilled staff to meet people’s needs and keep them safe. They were actively recruiting new permanent staff for the service so that people would receive consistent care from staff who knew them well. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.
Right Culture
The provider had improved the culture of care at the service. Staff now placed people’s wishes, needs and rights at the heart of everything they did. The home manager had good oversight of the service and understanding of people’s needs. Staff evaluated the quality of support provided to people, involving the person and their families and other professionals as appropriate. The service valued and acted upon people’s views. People’s quality of life was enhanced by the service’s improved culture of improvement and learning from incidents.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 20 May 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced inspection of this service on 6 April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve dignity and respect, safe care and treatment and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, caring, and well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Foxley Lane on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
About the service
Foxley Lane is a residential care home providing personal care to 7 people at the time of the inspection. The service can support up to 8 people.
People’s experience of using this service and what we found
Right Support
The service did not always make sure people received care and support in a safe and clean environment. Risks to people’s safety had not been fully mitigated and people were at risk from infection and hygiene risks. Staff did not always support people with their medicines to achieve the best possible health outcome. Information about some of the medicines people took was not accessible to staff when required, which might have delayed when they received this. Records of medicines stock were not always accurate so staff could not be assured they had the right quantities in stock. However, we saw people received their prescribed medicines at the right time. The provider could not be assured staff supported people to achieve their aspirations and goals. Staff had not met regularly with people to assess and review people’s progress in achieving positive outcomes.
The service supported people to have the maximum possible choice, control and independence. The environment was well equipped, well-furnished and mainly well-maintained to support people to meet their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. People benefitted from the interactive and stimulating environment. Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.
Right Care
People did not always receive kind and compassionate care. We saw staff did not always use positive, respectful language when interacting with people or when discussing people with others. Staff did not always engage with people when they were supporting them.
Staff understood people’s cultural needs and provided culturally appropriate care. Staff understood and responded when people needed space or privacy. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
Right culture
Staff turnover at the service had been high so people were not always supported to receive consistent care from staff who knew them well. The service lost a significant number of staff after it became a legal requirement for all care staff to be vaccinated against COVID-19. New staff were quickly recruited. However, new staff had not been given enough support to develop their knowledge and understanding of people and their needs so did not know people as well as they could. People’s quality of life was being impacted by some staff who did not demonstrate the values, attitudes and behaviours required to support this. The provider was addressing these issues with a programme of improvement aimed at supporting people to achieve positive outcomes in all aspects of the care and support they received.
People received the care and support they required as staff had been trained to meet their needs and wishes. Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, including advocates, were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 11/10/2019).
Why we inspected
We received concerns in relation to; poor leadership and management at the service, poor communication with relatives, poor staff culture, high turnover of staff, new staff poorly trained, staff slow to seek support for people with deteriorating healthcare needs and people not being engaged or stimulated. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. When we inspected we found there was a concern with the dignity and respect shown to people so we widened the scope of the inspection to include the key question of caring.
We 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 COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvement. Please see the safe, caring and well-led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We have identified breaches in relation to dignity and respect, safe care and treatment and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will 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.
People were in regular contact with their families. Relatives were able to visit people in the communal garden and staff made sure this was done in a safe way. When relatives were not able to visit, they kept in touch with people through video and telephone calls. Staff kept relatives regularly updated about people through telephone calls and emails.
Staff screened all visitors to the service for symptoms of infection and gave them information about the safety procedures they should follow to ensure theirs and people’s safety. People and staff were also screened twice a day to monitor for signs and symptoms of a possible infection. People and staff were tested for COVID19 at frequent intervals, in line with current guidance. To reduce cross infection risks, staff only worked at this location.
All staff had been trained in current infection prevention and control (IPC) guidance and in the use of personal protective equipment (PPE). There were designated areas for donning and doffing of PPE and handwashing facilities were easily accessible to people, staff and visitors. We observed staff followed current guidance and practice throughout our visit.
Enhanced cleaning took place throughout the environment on a daily basis. We observed the environment was clean and hygienic. Communal spaces were used creatively to ensure people could continue to interact with each other and staff in a safe way.
The registered manager was the designated lead for IPC at the service and undertook regular audits to make sure staff complied with current guidance and practice. Any concerns picked up through these checks were acted on without delay.
The service’s IPC policy was up to date and in line with current guidance. The service had plans in place to respond immediately and appropriately to an outbreak of infection to ensure the safety of people and staff.
Further information is in the detailed findings below.
Independence Homes – 37 Foxley Lane is a residential care home providing personal care to people aged 18 and over with learning disabilities and/or autism. The home can support up to eight people and at the time of the inspection, eight people were living in the home.
The home has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. The service supported people with learning disabilities and/or autism in line with these principles.
The home was situated in a residential area close to the town centre. The home’s building design fitted into the residential area and other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.
People’s experience of using this service and what we found
The home was safe. There were procedures to protect people from abuse. Risks associated with people's needs were assessed and staff understood how to reduce these risks.
People were supported with their medicines, which were managed, stored and recorded safely. Staff followed infection control procedures. There was a procedure to review accidents and incidents in the service to prevent reoccurrence. Staff were recruited safely and their backgrounds checked before they started working for the service.
Staff were supported with training and development to ensure their skills and knowledge were up to date. 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. We have made a recommendation for the provider to ensure consent records were reviewed because we found some were not up to date.
People were supported with maintaining their health and nutrition. The home worked in collaboration with health care professionals, such as GPs, nurses and physiotherapists to ensure people's health needs were met.
Staff were respectful and caring towards people. Staff communicated with them appropriately according to their communication needs. Staff understood the importance of promoting equality and diversity.
People's communication needs were met and they were supported with information they could understand. However, we have made a recommendation for the registered manager to follow best practice on the Accessible Information Standard (AIS) because the registered manager and staff were not fully aware of it.
Care plans were personalised and people were encouraged to maintain their independence and attend community events or activities. People or their relatives were supported to make complaints to discuss concerns they had.
Staff felt supported by the management team. Quality assurance systems included obtaining feedback from people and relatives. They learned lessons when things had gone wrong to help make improvements to the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (report published 10 March 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
The service provides specialist residential care for up to eight people living with epilepsy and other neurological or physical needs. At the time of our inspection there were seven people with complex needs using the service.
The service had a 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.
Relatives of people using the service and staff told us people were safe. Staff had completed safeguarding training and understood their personal responsibilities. Handovers between shifts ensured staff were aware of what had been happening and how people were. Staff were always in close proximity to people in communal areas. The service had provided a safe environment for people using the service. Equipment used by the service was modern, well maintained and relevant to people’s needs. Risk assessments reflected people’s needs, preferences and goals and supported staff to provide safe and appropriate care. There were sufficient numbers of suitably trained and qualified staff to meet people’s complex needs.
Staff were supported with extensive training and regular supervision meetings. The service was working within the principles of the mental Capacity Act. We found relatives where appropriate were involved in the planning of people’s care and support. People’s nutritional requirements were met through a varied diet and the availability of drinks and snacks at all times. The service ensured people’s healthcare needs were met and staff were given further support by access to a specialist epilepsy nurse and an epilepsy specialist who were available to provide advice at any time.
Relatives and healthcare professionals spoke positively about the service and staff. We observed and listened to people and staff. Staff communicated well and people responded positively. Relatives of people were involved in the ongoing planning of care and support. People’s preferences were taken into account when providing care and support and their choices respected. Staff treated people with dignity and respected their privacy.
Detailed preparations and assessments took place before people moved into the service to ensure everything was in place to meet their complex needs. The care provided was person centred and responsive to people’s needs. Care records, including person centred plans and delivery plans were written using person centred language. The service provided specialist care for people living with epilepsy and enabled staff to do so through extensive training and the availability of clinical advice and support. The service ensured they were up to date with recognised good practice and liaised closely with healthcare professionals. The service had access to two vans enabling them to support people to attend appointments and providing opportunities for activities. Activities played an important part in people’s lives and staff had the confidence and experience to take people out on planned and unplanned activities. The provider had processes in place to obtain feedback and ideas from the relatives of people using the service and using that information where deemed appropriate to improve service provision.
Staff and relatives spoke positively about the management team at the service. They felt confident they could raise any concerns or issues. Staff meetings were held once a month. The service had a system of reviews, checks, visits and audits to assess, monitor and improve service provision.
Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well led?
Below is a summary of what we found. The summary is based on our observations during the inspection, looking at records and speaking with the relatives of people using the service, and members of staff. People using the service were unable to express their experiences verbally as a result of their complex needs.
Please read the full report for evidence that supports our summary.
Is the service safe?
People were cared for in an environment that was safe, clean and hygienic. One person told us, “Never had concerns about cleanliness.”
We found that staff were supported with regular training and supervision to provide safe and appropriate care. One relative of a person using the service told us, “They make it feel like a home.” A visitor commented, “I think they have been absolutely wonderful here.” Members of staff treated people with respect and dignity.
We saw that there were effective recruitment and selection policies in place. Appropriate checks on staff took place before they started their employment.
We looked at a random selection of care files and delivery plans for people using the service. We found that they were person centred and reflected the individual needs of each person. We saw they covered a comprehensive range of care and healthcare needs including individual risk assessments. We found that they were regularly reviewed and up to date which supported staff to deliver safe and appropriate care.
We found that there were procedures in place to deal with foreseeable emergencies. For example, people were at risk from seizures. Procedures were in place to monitor and respond to seizures and staff were trained to administer emergency drugs. Members of staff were first aid trained and received fire safety training once a year.
People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.
The Care Quality Commission monitors operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that they had policies and procedures in place in relation to DoLS. People using the service had their mental capacity assessed and recorded. We were assured by the manager that they would reassess people using the service in light of recent judgements and subsequent guidance in relation to DoLS.
Is the service effective?
People’s needs were assessed and care and treatment was planned and delivered to reflect their needs. We were told that an assessment of people’s needs was carried out before people came to the home.
People using the service were encouraged to take part in a wide range of activities. We saw a timetable of activities displayed.
Is the service caring?
We observed staff interactions with people at various times in our inspection. They were friendly and inclusive. Relatives commented positively about staff and the care they provided. One person commented, “High quality care.”
Is the service responsive?
Relatives were involved in making decisions about people’s care and treatment. We saw that care planning was person centred and recorded how people preferred their care and treatment to be delivered.
The provider employed a specialist epilepsy nurse and a learning disability nurse to support staff with advice and training. They also ensured that the service provided reflected advances in epilepsy treatment and published research.
Is the service well led?
People’s representatives and staff were asked for their views about their care and treatment and they were acted on. There were a number of audits in place to monitor and assess service provision.
Relatives, visitors and members of staff told us that the manager and deputy operated an ‘open door’ policy and were approachable.
We found that care plans were personalised and reflected people's needs. Medication was appropriately stored and administered. The home had been purpose built for people with epilepsy and had up to date equipment and facilities to meet their needs.
We found that there were sufficient numbers of staff who were appropriately trained and experienced. The home had an effective sytem to deal with complaints and comments.
We saw that people living at Independence Homes Foxley Lane were well cared for by a well trained staff team who liked working there, were very enthusiastic about their work and committed to providing a high quality service for the people they supported. A lot of attention was paid to the individual needs and preferences of people living there and there were enough staff to ensure these could be met.
The systems in place to ensure that care was appropriate and safe were thorough and up to date and the building was appropriate for the needs of people, very pleasant and well maintained. Parents and friends of people living there were confident that people living there were well cared for and safe. They said that “it’s really lovely here; the staff are really friendly”; “it’s a real home for people” and that staff and the manager were “excellent” and “first class”.
During our visit people were relaxed and showed signs of well being when interacting with both the staff and other people using the service. We observed that staff were attentive and that people were given time to try and express their needs. Staff demonstrated a good understanding of each person's communication style or body language and knew how to respond to individual needs.
People's needs are regularly reviewed to make sure they get the right care and support. When a person's needs change, the service is good at making sure that appropriate action is taken. This includes consultation with other relevant healthcare professionals and making any necessary adjustments to people's care and support plans. Staff in the home and other health professionals closely monitor each person's epilepsy needs to ensure that they stay as well as possible.
We saw that people were provided with a range of personalised and meaningful activities and supported by staff on a one to one basis. People benefit from a stable staff team who have worked at 37 Foxley Lane for a number of years.
Staff told us that they were happy working at the home and described the training as 'excellent'. Staff felt well supported by the registered manager and deputy. They felt there was good teamwork and a positive atmosphere. Comments included, 'everyone's very professional', 'good rapport with the parents' and 'there is good information share.' Staff described the manager as 'very much hands on, absolutely brilliant', 'efficient 'and 'fair'.
A visiting professional told us,' the service is very personalised and they recognise people's individual needs. The communication is good and staff use their initiative well.'
Please refer to each outcome below and within the main report for more detailed comments about specific aspects of the service.
We would like to thank all those who took part in this review for their time, assistance and hospitality.