Archived: Loxley Court

We carried out this inspection on 20 July 2015 and it was an unannounced inspection. This means the provider did not know we were going to carry out the inspection. At the last full inspection carried out in November 2014, we found the home to be non-compliant with the following regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010; 10; Assessing and monitoring the quality of service provision, 13; Management of medicines, 18; Consent to care and treatment and 22; Staffing. Compliance actions were given for regulations 13, 18 and 22 and a warning notice was issued against regulation 10. We followed up on these breaches during this inspection.

Loxley Court Care Home is located on the outskirts of Sheffield. It caters for up to 76 older people whose needs may include mental health or dementia. Nursing care is provided. Accommodation is provided over three floors, accessed by a lift, which includes a challenging behaviour unit on the ground floor for up to ten people. There are three double bedrooms, the remainder of the rooms are single. Each bedroom has an ensuite toilet. There are lounges and a dining area on each floor of the home. On the day of our inspection, there were 38 people living at the home, some living with dementia and one new admission.

It is a condition of registration with the Care Quality Commission that the home has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the home is run. The registered manager was present on the day of our inspection.

People and their relatives told us they felt the home was safe, effective, caring, responsive and well led. Comments included; “[The home] is a safe place to be”, “[Staff] always ask me what I want doing and how they should do it”, “People are so kind, I never thought I’d be this happy in a home but it’s great” and “I go to residents meetings when I can. It’s a good time to tell [staff] what we think about the home. And it’s a good place to chat.”

People were protected from abuse and the home followed adequate and effective safeguarding procedures. Care records contained personalised and relevant information for staff to assist in providing personalised care and support.

Staff told us they felt well supported and they received regular supervisions. Training updates were provided regularly and training targets were measured on a ‘red, amber, green’ scale, where red meant that training or updates were required and green meant training had been completed. Where staff wanted to attend any other training courses, they were able to request this as part of their supervisions.

We found good practice in relation to decision making processes at the home, in line with the Mental Capacity code of practice, the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

The registered manager carried out regular audits at the home and recorded any required actions on audits and on the ‘home action plan’. Actions that had been identified as a result of audits were verified and signed off by the registered manager when they had been addressed and completed.

As a result of concerns raised by the local authority an inspection took place on 11 November 2014. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. The service was last inspected on 1 May 2014 and was meeting the requirements of the regulations we checked at that time.

Loxley Court is a nursing home that provides care for up to 76 people. It is a purpose built care service. At the time of the inspection the provider had made a voluntary decision not to admit any further people to the service. There were 47 people were living at the service. The service has three floors; the ground floor unit is primarily used for people who have behaviour that may challenge others.

The registered manager for this service was no longer in post and not managing the regulated activities at this location at the time of the inspection. The registered manager was in the process of cancelling their registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

One of the provider’s senior homes managers was acting as the manager of the service. The acting manager told us they were actively recruiting new staff to work at the service. In the meantime, the service was using agency and bank staff whilst they recruited more permanent staff.

During the inspection we found that some people’s daily records were not being updated on one of the units and were being filled in later in the day. Staff explanation was they were too busy supporting people and there were two agency workers on the unit who did not know people or their care needs well. Staff were unable to confirm whether several people had actually received the care they needed. For example, two people who required repositioning regularly to reduce the risk of them developing pressure sores but we could not evidence this had occurred. This showed that the service was not meeting requirements to ensure that a sufficient number of suitably experienced staff was available to meet people’s needs.

People told us they felt “safe”. Some people who lived at the service had complex needs and we were not able to verbally communicate with them so they could share their views and experiences with us. Our observations did not identify any concerns regarding safeguarding of people who lived at the service. Most of the relatives spoken with felt their family member was safe.

Staff had received training in safeguarding vulnerable adults as part of their induction training. Our discussions with staff told us they were aware of how to raise any safeguarding concerns.

We saw evidence that checks were undertaken of the premises and equipment. However, we found that daily checks were not undertaken to ensure air mattresses were set correctly. For example, we found one air mattress did not have the correct settings prescribed for the person.

People told us they were treated with dignity and respect. Relatives spoken with told us they felt their family member was treated with dignity and respect. During the inspection we observed positive and a few negative interactions between people and staff. We observed staff giving care and assistance to people. They were respectful and treated people in a caring and supportive way. However, we saw a few interactions where people were not treated with consideration or respect. For example, a staff member discussing a person’s behaviour that may challenge others in front of other people.

The service did not have appropriate arrangements in place to manage medicines to ensure people were protected from the risks associated with medicines.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as suitable to work at the service.

People spoken with told us they were satisfied with the quality of care they had received and made positive comments about the staff. Relatives spoken with also made positive comments about the care their family members had received and about the permanent staff working at the service.

Individual risk assessments were completed for people so that identifiable risks were managed effectively. There was evidence of involvement from other professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners.

People’s nutritional needs were monitored and actions taken where required. People’s preferences and dietary needs were being met.

Staff told us they enjoyed caring for people living at the service. Permanent staff were able to describe people’s individual needs, hobbies and interests, life history, likes and dislikes and the name people preferred to be called by.

Staff received induction training for their roles. However, some staff refresher training was overdue which meant staff had not been supported to maintain their skills and develop their knowledge. Staff had not received regular supervisions and appraisals which meant their performance was not formally monitored and areas for improvement may not have been identified. This meant the service did not ensure staff received appropriate training, professional development, supervision and appraisal.

On the day of the inspection three people had been supported to go on a trip to the butterfly park. During the inspection we observed musicians playing in one the units; relatives told us they regularly visited the service.

The service had a complaint’s process in place and had responded to people and/or their representative’s concerns, investigated them and taken action to address their concerns.

The service had not held regular meetings with people living at the service and/or their relatives or representative. This meant people and/or their relatives or representatives did not have sufficient opportunities to be kept informed about information relevant to them.

The provider had not ensured there were effective systems in place to monitor and improve the quality of the service provided. This meant they were not meeting the requirements to protect people from the risk and unsafe care by effectively assessing and monitoring the service being provided.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.