Foxton Court

because our overall rating of the service has not changed since our last inspection.

Foxton Court 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 a purpose facility with accommodation in single rooms all of which have en-suite facilities. The home is not registered to provide nursing care.

The home had a registered manager in post, although this individual was now working as the provider’s quality director and the deputy manager was acting up into the role of the home manager.

Risks within the service were recorded, monitored and reviewed. The provider had a safeguarding policy in place and staff understood safeguarding matters. Sufficient staff were employed to support people's personal care needs. Some people felt staff could be busy at times but this did not affect the quality of care they received. Medicines in the service continued to be managed and monitored appropriately. The service was maintained in a clean and tidy manner.

People's needs were assessed and care delivered in line with these needs. Staff had undertaken a range of training and had sufficient skills and experience to support people with individual care. Staff were subject to regular supervisions and an annual appraisal. People were supported with a healthy diet and specialist requirements were supported and catered for.

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. Family members were involved in decisions as much as practical. The environment was homely, warm and welcoming. People's rooms were personalised.

People appeared happy and relaxed in staff company and we noted good relationships between staff and people who used the service. Relatives we spoke with praised the care and told us their relations were well looked after. People were supported to make day to day decisions and were involved in care plan reviews, although these were not always clearly noted in monthly reviews. People's privacy and dignity were respected and staff promoted and encouraged independence.

Care records contained information that supported staff to deliver care that met the individual's needs. Care was reviewed and families were involved in these reviews. People were supported to access a range of events and activities. There had been seven recent formal complaints about the service which had been dealt with formally and appropriately.

People and families told us the acting manager was approachable and helpful. Staff told us they were friendly and supportive. Some staff told us teamworking could be an issue at times. The manager told us, and records confirmed this was being addressed.

Regular audits and checks were in place to monitor the quality of the service. Records were maintained and up to date. Daily records were regularly completed. The service was meeting legal requirements by displaying the current quality rating and submitting notifications to the Commission.

The inspection took place on 24 April and was unannounced. The inspection team consisted of one inspector. The service was previously inspected on 28 August 2014 where all regulations we inspected at that time were met, with the exception of management of medicines. At a follow up inspection on 26 November 2014 the previous breach in this regulation was met.

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 service is run.

People told us they felt safe. There were safeguarding policies and procedures in place and staff knew what action to take if abuse was suspected. They had received training related to the protection of vulnerable adults. There were no ongoing safeguarding concerns and this was confirmed by the local authority safeguarding adult’s officer.

Risks associated with the building and equipment were assessed and routine safety checks were carried out. For example, individual risk assessments were carried out in relation to people’s risks of falls, nutritional risks and skin integrity. The manager maintained an overview of risks and health and safety audits were carried out by senior managers from the organisation. Accidents and incidents were appropriately recorded and analysed by the manager to identify any recurring trends or concerns.

Safe recruitment procedures were in place. There were minor gaps in one recruitment record that we checked. Applicants had been checked by the Disclosure and Barring Service (DBS). DBS checks ensure staff working at the home have not been subject to any actions that would bar

them from working with vulnerable people.

There were suitable numbers of staff present in the home on the day of the inspection. Some staff expressed concerns that at times there were insufficient staff on duty for them to feel able to fully meet people’s needs. We discussed this with the manager and operations manager who told us that staffing levels were satisfactory. We have made a recommendation that they continue to monitor this in light of staff concerns.

The service was clean and well maintained. Infection control procedures were followed and relatives commented specifically about the “spotlessness” of the home.

Staff received regular training and felt well supported to develop and learn new skills. Supervision and appraisals were conducted regularly and staff had the opportunity to complete face to face and online training. A training academy had been established at head office and staff told us they had enjoyed the experience of attending training there.

Staff had received training related to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service was working within the principles of the MCA and decisions taken in people’s best interests had been appropriately recorded.

People were supported with eating and drinking. Staff provided support sensitively and discreetly at mealtimes. There were mixed views about the food and people were encouraged to give their feedback about the meals which were passed straight to the kitchen. Some suggestions had already been acted upon. Special dietary requirements were catered for, and people at risk of malnutrition were identified and appropriate action taken. Innovative use of techniques and equipment were used to enhance the mealtime experience of people with swallowing difficulties who required their food to be pureed, or those who were unable to swallow liquids safely. The techniques improved the appearance of foods to look like a regular meal, and enabled people to eat some foods with a fork which promoted independence and enhanced dignity. Liquids infused with bubbles could be taken safely on a spoon, providing a refreshing sensation.

The health needs of people were met. People had access to a range of healthcare professionals and specialist advice was sought when required, for example from specialist nurses or dieticians.

Staff were observed to be kind and patient in their interactions with people and we saw a lot of laughter and joking between staff and people. People were enjoying the celebrations for the Queen’s birthday on the day of our inspection and staff had decorated the service with union jack bunting and arranged for a cake for people to be made so they could all sing happy birthday. The celebration was very popular and lunch was delayed as some people were reluctant to leave the party. The choices of people were respected.

Care plans were in place which were person centred and took into account people's personality, behaviour, likes, dislikes and previous experiences. These were evaluated regularly.

A range of activities were available including group and individual sessions. There were weekly trips and people had been supported to fulfil a wish, including going to watch a football match and having a pint of beer afterwards, and eating fish and chips from the chip shop. An activity called “HEARTS” provided a relaxing sensory experience with empathy, warmth and reassurance being the goal.

A complaints procedure was in place and relatives knew how to make a complaint. One complaint was recorded and this had been responded to appropriately by the manager.

The registered manager was due to retire and a manager had relocated from another home in the organisation. People staff and relatives felt the service was well led. Relatives told us they could not think of anything that could be improved.

There were various staff recognition and incentive schemes and staff told us they appreciated this and felt valued by the organisation.

Below is a summary of what we found.

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

Is the service safe?

At this visit we found that improvements had been made in the handling of medicines. Appropriate arrangements were now in place to ensure that medicines were managed safely.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found.

Is the service caring?

We saw that people were supported by kind and attentive staff who displayed patience and gave encouragement when supporting people, for example when assisting them with mobility. People appeared content and looked well cared for. Our observations confirmed that generally most people were independent and staff encouraged this, whilst ensuring that they offered assistance to people if they required help. People told us that they were happy with the care and support they received from the service. One person said, "I am cared for very well. The care is remarkable." Another person told us, "The care here is very good, they know what I need."

Staff were fully aware of people's care and support needs. Staff told us, and people confirmed that they pursued activities inside the home regularly and at times they accessed the community. This showed the provider promoted people's well-being.

Is the service responsive?

The provider had arrangements in place to review people's care records regularly and we saw that amendments were made to people's documentation as their needs changed, to ensure this remained accurate and any issues were promptly addressed.

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as district nurses or doctors they received this care. One visiting district nurse told us, "The girls (staff) are really good here. They take our advice on board."

People had a wide variety of foods available to them and confirmed that they were given choices. People's weights and food and fluid intakes were monitored if needed and referrals had been made to dieticians where necessary, to ensure they received specialist input into their care to remain healthy.

Is the service safe?

People told us they felt safe and the care we observed was delivered safely. In most cases risks that people may be exposed to in their daily lives and in relation to their care needs had been considered. We saw that instructions had been drafted for staff to follow to ensure people remained safe in light of these identified risks.

We reviewed the arrangements in place for the management of medicines. We found that these arrangements were not appropriate as individual stocks of medicines did not always tally with what had been received and administered. We found that medication care planning and risk assessments were not of the required standard. We have set a compliance action and we have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.

People had equipment at their disposal to aid them to live as independently as possible and to move around the home with minimal support from staff. We saw that all of this equipment was well maintained and where appropriate serviced in line with manufacturers guidelines or best practice advice.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We discussed the recent Supreme Court judgement handed down on 19 March 2014 in the case of 'P v Cheshire West and Chester Council and another' and 'P and Q v Surrey County Council', about what constitutes a deprivation of liberty. The manager advised us that they were aware of this ruling, and had already liaised with their local authority safeguarding team for advice on their responsibilities and they have begun to put arrangements in place, for people in their care.

Is the service effective?

People told us they were happy with the staff who cared for them and that they met their needs. One person said, "The staff are very responsive to my needs." Another person told us, "It's an excellent place here. The staff are excellent." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.

Staff told us that they felt supported by the manager and the provider, and we saw that supervisions and appraisals took place regularly. Training records showed that staff were equipped with the necessary skills to carry out their jobs effectively and that training was monitored effectively and kept up to date.

Is the service well-led?

A registered manager was in post at the time of our inspection. Staff said they felt supported by the manager and people and relatives that we spoke with felt the service was managed effectively.

The provider had policies and procedures in place which gave direction and instruction to staff.

Meetings for staff, people and their relatives were held regularly. Audits related to medication, care planning, health and safety and infection control were carried out to identify any issues or concerns. In addition, records of accident and incidents that took place within the home were regularly reviewed in order to identify any patterns where people's care needs may have changed, and care delivery may need to be altered. We saw that the provider had responded appropriately where issues needed to be addressed, in order to ensure that the service remained effective and well led.

People told us their consent was gained prior to care being delivered and we found that staff acted in accordance with their wishes. Where appropriate we found the provider acted in accordance with legal requirements where people did not have the capacity to give consent themselves.

We found people's care and support needs were appropriately assessed and their care was planned. They received care safely and to an appropriate standard.

We found people received sufficient food and fluids and were protected from the risks of inadequate nutrition and dehydration.

People were cared for in a clean and hygienic environment and we found the service had appropriate measures in place to monitor and manage infection control.

We found there were enough suitably skilled and qualified staff on duty to met people's needs safely and appropriately.

We saw the provider had a complaints policy and procedure in place and people told us they would confidently raise any concerns they had with the manager.

People said they could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within the home and community. People we spoke with said, "I enjoy getting out and about" and "This is my home aren't I lucky."

People told us their home was clean, comfortable and warm. They said "Come and see my room it caters for everything I need." They said staff were kind and caring and seemed to be well trained. People confirmed they were given the opportunity to comment on the service, change routine or raise complaints. They said their visitors were made to feel welcome and information sharing was good.