Archived: Foxearth Lodge Nursing Home

Foxearth Lodge Nursing Home is a residential care and nursing home, providing personal and nursing care to 62 older people at the time of the inspection. Some people were living with dementia. The service can support up to 67 people across two units, Woodlands, for people living with dementia and Foxearth Barns which provides care and nursing care, some people living on this unit also lived with dementia.

People’s experience of using this service and what we found

People received a service from staff who understood how to keep them safe from abuse and avoidable harm. Systems supported effective assessment and mitigation of risks. People were provided with a clean and hygienic environment to live in. Medicines were managed safely. Systems were in place to provide people with support from staff when needed. Recruitment of staff was done safely.

People were cared for by staff who had received training to meet their needs. 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 received effective health care and there were systems to ensure their dietary needs were met. The environment was suitable for the people who lived there.

People received a caring and compassionate service. People’s independence and privacy was respected. People choices about their care was promoted and respected.

People received individualised care to meet their assessed needs. People were asked for their choices about the care they received at the end of their lives at this was respected. People had the opportunity to participate in activities which interested them. There was a complaints procedure in place and people’s concerns and complaints were addressed in a timely way.

Systems to assess and monitor the service people received were in place. These had improved since out last inspection and any shortfalls were identified and addressed. There was a service improvement plan in place which demonstrated that they continued to develop.

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 14 August 2018) and there were multiple breaches of regulation. 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

This was a planned inspection based on the previous rating.

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.

There were 56 older people, some living with dementia, living in the service when we inspected on 25 and 28 June 2018. This was an unannounced comprehensive inspection.

At our previous inspection of 26 March 2015, this service was rated good overall. At this inspection of 25 and 28 June 2018 the overall rating had deteriorated to requires improvement. We have identified breaches in Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009.

The full version of this report shows what actions we have asked the provider to take.

There was not a registered manager in place. 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.

Since our last inspection there had been management changes with the registered manager who worked at the service during our last inspection de-registering in August 2018 and another registered manager being in place from October 2017 to June 2018. The provider’s and previous registered manager’s systems to assess and monitor the service had not been robust. They had failed to independently identify shortfalls in the service and address them in a timely manner. Records including incidents and accidents, people’s behaviour records and food and fluid records had not been reviewed and analysed to identify trends and reduce future risks to people.

There was a new manager working in the service since 18 June 2018. They were planning to submit an application to the CQC to be registered manager. Since the time the new manager had been in place, they and the provider’s management team had drawn up a service improvement plan, which identified shortfalls in the service and an action plan was in place to address them. The action plan was dated 23 June 2018 and was still in the early stages but the management team were in the process of implementing changes. These needed to be fully implemented and embedded in practice to assess how these benefitted people who lived in the service.

Notifications relating to injury and safeguarding had not been made to CQC as required by law. Since 2016 we had not received any notifications of injury and only one notification of safeguarding in 2017. We reviewed the service’s records and found that there were incidents of injury and safeguarding which we should have been notified of.

Improvements were needed in how the service assesses and mitigates risks to people. This included in people’s care plans and risk assessments and how they guide staff in the reduction of assessed risks.

The systems in place for medicines management were not robust to ensure that they were safe at all times. The new manager had identified shortfalls and an action plan was in place to improve this.

The numbers of staff required to meet people’s needs were calculated. At the time of our inspection we saw that people were provided with assistance when they needed it. We identified an issue with the staff recruitment processes, this was addressed immediately, once we pointed it out.

There were infection control systems in place to reduce the risk of cross contamination. The environment was well maintained and suitable for the people using the service.

There were gaps in staff training records and the new manager had identified gaps in staff supervision. They had developed a plan to improve this.

People had access to health professionals when needed. Staff worked with other professionals involved in people’s care. People’s nutritional needs were assessed. However, the records in place to monitor how much people had to eat and drink were not complete and used effectively.

People’s records relating to if they had capacity to make their own decisions were confusing and did not clearly identify that people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People’s privacy and dignity was not always respected. People shared mainly positive relationships with staff.

People were listened to in relation to their choices, however, there was not evidence to show that they had been involved with their care planning.

Improvements were needed in how people’s care was assessed, planned for and met. People’s comments varied about if they had access to social activities to reduce the risks of isolation and boredom.

People’s choices were documented about how they wanted to be cared for at the end of their life.

There was a complaints procedure in place and people’s complaints were addressed.