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Inspection Summary

Overall summary & rating


Updated 3 April 2019

About the service:

Fox Elms Care Limited provides personal care to people with a learning disability, mental health or acquired brain injury living in their own homes or supported living in Gloucestershire.

People’s experience of using this service:

• The staff told us about the issues with the landlord and told us that some tenancy agreements were not adhered. We noted that external environments were not well maintained and where housekeeping was the responsibility of the landlord this was not happening. We recommend that the registered manager seek guidance from a reputable source or inform commissioners of placements that landlords were not adhering to their contracts.

• Staff that administered medicines had attended appropriate training. Medicine administration records were signed to indicate medicines administered. Some MAR did not include the medicines received. Where medicines were discontinued or duplicated it was not made clear in the MAR.

• Quality assurance systems were in place. Where shortfalls were identified action was taken to improve the quality of service delivery. Incident and accidents were reported and analysed for patterns and trends.

• We received feedback through questionnaires about the agency which we followed up during the inspection. Questionnaires were sent to people, relatives, staff and community professional before the inspection. The registered manager said that at the time morale was low due to changes in staff rotas and registration changes. The relatives and staff we spoke with during the inspection gave positive feedback about the care and treatment people received.

• New staff said they had an induction to prepare them for their role. They said their induction included shadowing more experienced staff.

• The training matrix confirmed staff attended training set as mandatory. Staff told us mandatory training was online at the agency office where the trainer was available for support.

• We saw copies of one to one supervision meetings which confirmed regular supervision. However, some staff said they had not had regular one to one supervision meetings.

• Staffing levels were maintained by agency staff. Staff told us there was enough time

allocated to deliver personal care and was not rushed. Most people living in supported living locations were having one to one support from staff.

• Recruitment procedures were in place and administrative staff were currently ensuring staff files were up to date. The registered manager told us action was being taken to recruit permanent staff.

• Care plans were mostly person centred. People’s life stories were introduced. Guidance from community professionals was part of the care plans. Individual risks to people included falls, choking and behaviours people used to express anxiety and frustration. Risks were assessed and action plans were developed on how to minimise the risk.

• Staff knew the day to day decisions people were able to make and Deprivation of Liberty Safeguards (DoLS) were made for people subject to continuous supervision.

• Where necessary staff made GP appointments. Staff said they were kept informed about visits from healthcare professionals.

• Complaints received were investigated and lessons were learnt from these events.

• The staff we spoke with told us how they ensured that people were made to feel they mattered. These staff explained the importance of developing relationships with people.

Rating at last inspection:

The service was rated as good at the comprehensive inspection dated 29 February 2016. The home retained the good rating in Safe at the focus inspection dated 10 January 2017.

Why we inspected:

This inspection was a scheduled inspection based on previous rating.

Follow up:

We will monitor all intelligence we receive about the service to inform when the next inspection should take place.

For more details, please see the full report which is on the CQC website at

Inspection areas


Requires improvement

Updated 3 April 2019

The service was not always safe.



Updated 3 April 2019

The service was effective.



Updated 3 April 2019

The service was caring



Updated 3 April 2019

The service was responsive.



Updated 3 April 2019

The service was well-led.