We carried out a review of the data available to us about Foxglove Care Limited - 3 The Causeway 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 Foxglove Care Limited - 3 The Causeway, you can give feedback on this service.
Foxglove Care Limited – 3 The Causeway is a small residential care home and is close to local shops and amenities. The service is registered to provide support to adults who may be living with a physical disability, learning disability and autism. The service was supporting three people at the time of our inspection.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Care:
Staff understood how to protect people from poor care and abuse, however the system to review safeguarding's was not always effective. We have made a recommendation about safeguarding. There were 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. We observed positive interactions between people and staff. People’s care and treatment support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. Relatives told us they were involved in care planning and could attend meetings. Staff assessed people’s risks appropriately and encouraged and enabled people to take positive risks.
Right Support:
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were supported by staff to pursue their interests and achieve their aspirations and goals. Relatives told us the service provided activities people enjoyed doing such as swimming, bowling and going out weekly for pub lunches. The service gave people care and support in a safe, clean, well-furnished and well-maintained environment. People were supported to make decisions following best practice in decision making and staff communicated with people in ways that met their needs.
Right Culture:
Staff knew and understood people well and were responsive, supporting their aspirations to live a quality of life of their choosing. Staff told us they enjoyed their job and making a positive difference to someone’s life. Staff turnover was low, which supported people to receive consistent care from staff who knew them well. People and those important to them were involved in planning their care and staff evaluated the quality of care provided to people, involving the person, their families and other professionals as appropriate. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. Relatives told us when they visited the service the atmosphere was good, staff were always pleasant and smiling and there is nothing they would change.
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 15 August 2019) and there were breaches of regulation. 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 15 August 2021. A breach of legal requirements was found. The provider was asked to complete an action plan after this inspection to show what they would do and by when to improve their governance systems.
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, effective and well-led.
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.
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 based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Foxglove Care Limited – 3 The Causeway on our website at www.cqc.org.uk.
We found the following examples of good practice.
• The service operated a booking system for visitors. All visitors were asked to complete a Covid-19 questionnaire and have their temperature checked before entering the service. All visitors had access to alcohol gel and face masks during their visit.
• Staff were wearing PPE in line with government guidance and designated areas were set up within the service for staff to remove and apply PPE.
• The service supported regular contact and communication with families. This included the use of technology, arranging safe outings in the local community and visits in the garden, whilst following social distancing guidance.
• People’s care plans reflected the support required to manage risks associated with the Covid-19 virus and provided staff information on how to maintain people’s wellbeing.
Further information is in the detailed findings below.
Foxglove Care Limited – 3 The Causeway is a small residential care home, in a residential area and is close to local shops and amenities. The service is registered to provide support to three younger adults who may be living with a physical disability, learning disability and autism. The service was supporting two people at the time of our inspection.
The service 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.
People’s experience of using this service and what we found
Staff worked closely with healthcare professionals but we found they had not sought advice and guidance for one person after a fall. Care plans did not always reflect the care and support people needed, though staff were knowledgeable about people’s needs and how to support them with their own routines.
Quality assurance systems had not identified care plans were not always updated or accurately recorded people’s needs. Monitoring of the service was completed but records were not always available to show this. People, their families, staff and relevant professionals were involved in the development of the service.
Staff were fun, kind and caring. Relatives were happy with the care provided and said, “It's like a little family. There is a nice atmosphere when I visit.” Staff respected people as individuals and maintained their privacy and dignity.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. People were supported to take part in activities they enjoyed in the local community.
People were supported by a small group of consistent staff who were able to identify and report any concerns. Recruitment, induction and ongoing processes helped ensure only suitable staff were employed and that they had the required skills and knowledge. Staff were supported by the management team and received supervision and annual appraisals.
Staff supported people to have a healthy, balanced diet, tailored meals to people’s personal preferences and offered people choices. People received their medicines as prescribed. People were encouraged to participate in activities within the care home and the local community.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Relatives and staff were happy with the management of the service; they could approach them at any time and were confident any issues would be quickly addressed. The registered manager had a ‘hands on’ approach to their role and used their own time to decorate people’s rooms. They were proud of the staff team and supported them in their professional development.
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 31 December 2016).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a breach in relation to the assessing, monitoring and addressing quality shortfalls at this inspection. Please see the action we have told the provider to take at the end of this report.
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.
This announced inspection took place on 25 November 2016; we gave the service 24 hours’ notice of the inspection because it is small and we needed to know that people and the registered manager would be in. The last inspection of the service took place on 13, 20 and 27 February 2015. The registered provider was non-compliant with the regulation pertaining to safeguarding vulnerable adults.
During this inspection we saw that the registered provider had taken action to ensure people who used the service were protected from abuse and avoidable harm which meant they had achieved compliance with the regulation.
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.
The people who lived at the home had complex needs which meant they could not tell us their experiences. We used a number of different methods to help us understand the experiences of the people who used the service including the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who were unable to speak with us. It was clear that the people who used the service trusted the staff who supported them. Staff looked for visual cues as well as listening to the tone and pitch of the sounds people made to understand what they were trying to communicate.
People who used the service were supported by suitable numbers of staff who knew how to keep them safe. The registered provider had developed plans to deal with foreseeable emergences. Staff had been recruited safely following the completion of appropriate checks. Medicines were ordered, stored and administered safely and people received their medicines as prescribed.
Staff were supported effectively and had completed relevant training to enable them to meet the assessed needs of the people who used the service. Staff understood how to gain consent from people who used the service; the principles of the Mental Capacity Act 2005 were followed when people could not make specific decisions themselves. People were supported to eat a healthy diet and drink sufficiently to meet their needs. People who used the service were supported by a range of healthcare professionals to ensure their needs were met effectively.
People who used the service were supported by caring and attentive staff who understood their needs and knew their preferences for how their care and support should be delivered. Staff explained things in a way that people could understand they made eye contact and changed their tone of voice when speaking. Staff treated people with dignity and respect and supported people in an inclusive and nurturing atmosphere.
The staff and registered manager were responsive to people’s changing needs. Reviews of people’s care took place on a regular basis; people and their appointed representative were involved in the initial and on-going planning of their care. Care plans had been created which focused on supporting people to maintain and develop daily living skills whilst remaining safe. People took part in a range of activities and went to social events. The registered provider had a complaints policy in place that had been created in a format that made it accessible to the people who used the service.
The service was led by a registered manager who understood their responsibilities to inform the CQC when specific incidents occurred. A quality assurance system was in place that consisted of audits, daily checks and questionnaires. Action was taken to improve the service when shortfalls were identified.
3 The Causeway is a three storey house situated in a residential setting close to local facilities including a shopping complex, restaurants, a cinema and a bowling alley. The home’s ground floor comprises a kitchen dining room and a separate laundry area. The first floor has one bedroom, a lounge and an office, the third floor has two bedrooms with en-suite facilities. At the time of the inspection there were three people living in the home.
This inspection was unannounced; it took place on 13, 20 and 27 February 2015. At the last inspection on 19 November 2013, the registered provider was compliant with all the regulations we assessed.
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.
People were not always protected from abuse and avoidable harm. Incidents of violent and aggressive behaviour were not always reported to the Care Quality Commission or the local authority safeguarding team as required. Investigations were not always completed; care and support plans were not updated to prevent future incidents taking place. We found that [the registered person had not protected people against the risk of abuse and avoidable harm. This was in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
A quality monitoring system was in place that consisted of audits, checks, monthly assessments and stakeholder surveys. We saw that when shortfalls were noted; action was taken to improve the service as required. However, the system required developing to ensure all shortfalls in care, treatment and support were highlighted as incidents of violent and aggressive behaviour that took place within the service were not always addressed or managed.
A formal supervision process was not in place which led to staff not receiving supervision and support as required. When we asked staff if they felt supported we received mixed responses.
The people who lived at the home had complex needs which meant they could not tell us their experiences. We used a number of different methods to help us understand the experiences of the people who used the service including the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who could not talk with us.
People had their health and social care needs assessed, support plans were developed which stated how staff should provide care and support using the least restrictive options. People were treated with dignity and respect throughout the inspection.
We saw that staff gave encouragement to people who lived at the home and supported them to make choices about their daily lives.
Staff were aware of people’s preferences for how care and support was to be delivered. We observed staff gaining people’s consent from non-verbal cues before support was provided. We witnessed staff giving encouragement to people and supporting them to make choices about aspects of their daily lives.
Staff did not always have the skills to communicate effectively. Although staff understood people’s non-verbal communication; what people were trying to convey with sounds and actions was not recorded accurately in a communication support plan.
People were supported to maintain a healthy balanced diet. When required, relevant professionals had been contacted for their support and guidance in this area.
Medicines were ordered, stored, administered or disposed of safely. Personalised support plans had been developed to ensure people received the medicines in line with their preferences and needs.
People were supported by suitable numbers of adequately trained staff who had been recruited safely. We saw evidence to confirm staff had completed a range of training deemed as mandatory by the registered provider.
Staff followed the principles of the Mental Capacity Act 2005 when people lacked capacity to make informed decisions. We saw evidence that best interest meetings were held accordingly. We found the home was meeting the requirements of the deprivation of Liberties safeguards (DoLS). These safeguards provide a legal framework to ensure that people are only deprived of their liberty when there is no other way to care for them or safely provide treatment.
People were supported by staff to undertake a range of social activities in the home and the local community.
We looked at two care records of people who used the service and saw that there were various entries of other health care professional's intervention.
The overall building maintenance was kept to a generally high standard and the grounds outside were sufficiently well kept and security gates were fitted which ensured people were kept safe.
Records we looked at included a staff induction programme that all new staff would be expected to complete. This ensured that all new staff received a consistent approach to induction that followed the common inductions standards skills for care.
A visiting relative we spoke with told us, 'I completed a survey last time round in august this year which asked us our views of the service.'
A relative told us: 'Staff at the home are wonderful and the management are really good people. They have just introduced coffee mornings with staff, management and other relatives which gives me the opportunity to share experiences.'
We spoke with a visiting health care professional and comments included; 'This home is pretty well run and one thing that really stands out for me is that the staff are keen to be here and the enthusiasm shown towards the people who use the service, proves that.' 'The staff engage very well with other services and they ring us for specialist advice when they need it.'
Staff told us that they used a series of questioning and checking their reaction, monitoring responses and observing different emotions for people who lacked capacity. This ensured people who use the service understood basic instructions and allowed them flexibility to make their own decisions.
We looked at specific medications that were administered to two people that used the service. We found that the quantities of medication administered, was accurate with the Medication Administration Record (MAR) entry.
Staff also told us that; 'I love working here and we have a good team.'