Background to this inspection
Updated
12 October 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team:
The inspection was carried out by one inspector, an assistant inspector, a CQC pharmacist specialist, a specialist nurse and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type:
Loxley Court is a 'care home'. People in care homes receive accommodation and nursing or personal care. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection:
This inspection was unannounced.
What we did:
Before this inspection we reviewed the information we held about the service, which included correspondence we had received and any notifications submitted to us by the service. Statutory notifications are information the registered provider is legally required to send us about significant events that happen within the service. For example, where a person who uses the service has a serious injury. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We contacted social care commissioners who help arrange and monitor the care of people living at Loxley court. We also contacted Healthwatch Sheffield. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.
During this inspection we spoke with four people. We spent time observing the daily life in the service to help us understand the experience of people who could not we could not speak with in a meaningful way. We spoke with 12 members of staff which included, the registered manager, two of the provider’s senior managers, the clinical lead, a nurse, four care assistants, a domestic, an administrator and the cook.
We looked at a sample of people's care records including their incident records. We checked a sample of people’s medication administration records and six staff files, which included recruitment checks, supervisions and appraisals. We also looked at other records relating to the management of the service, such as quality assurance documents. We looked around the building to check the home was safe and clean.
After the inspection we sought information from the registered manager about the action taken in response to the concerns found relating to the management of medicines. The registered manager sent us details of the action taken in response to these concerns and supporting evidence. The registered manager also sent us evidence to confirm the lift had been mended and was in full working order.
Updated
12 October 2019
About the service:
Loxley Court is a 'care home'. People in care homes receive accommodation and nursing or personal care. The service can accommodate up to 76 people across four separate units. At the time of the inspection one of these units was closed. One of the units specialises in providing care and support to men living with mental health difficulties and associated behaviours that can challenge. There were 39 people living at Loxley Court at the time of this inspection.
People’s experience of using this service and what we found
We found the arrangements in place to manage medicines so people were protected from risks associated with medicines required improvement.
There were systems in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of people who used the service. However, we saw the system in place to ensure any incidents were uploaded quickly into the person’s electronic care plan required improvement. We saw the guidance for staff on what to do if a person was becoming agitated or aggressive would benefit from being more detailed in some people’s care plans.
The registered manager and provider had an overview of the service. The registered manager and provider identified any areas for improvement and planned changes to the service to ensure it provided high-quality care. However, we saw some of the checks completed for the management of the medicines and people’s care plans required improvement.
At our last inspection we found concerns about the staffing levels at the service and the level of agency staff working at the service. At this inspection we found action had been taken to ensure there were enough permanent staff employed at the service.
People we spoke with did not express any worries or concerns. Safeguarding procedures were robust and staff understood how to safeguard people. People were cared for by suitably qualified staff who had been assessed as safe to work with people.
At our last inspection we saw people were not always treated with dignity and respect. At this inspection the culture within the service had improved. During the inspection we observed staff giving care and assistance to people. They were respectful and treated people in a caring and supportive way. People spoken with described the staff as kind and caring. The service was clean and had a welcoming atmosphere.
People told us they were satisfied with the quality of care they had received. People were supported by staff who knew them well. People had access to external health professionals to help promote good health and mental health wellbeing.
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.
At our last inspection we found the systems in place to ensure staff received training to support them in their role required improvement. At this inspection we found action had been taken to ensure staff had undertaken training which was regularly updated to ensure they had the skills and knowledge to support people effectively. There was a robust process in place to ensure staff received regular supervision and an annual appraisal.
People made positive comments about the quality of food provided and told us their preferences and dietary needs were accommodated. People’s nutritional needs were monitored and actions taken where required.
There was a range of activities on offer to people living at Loxley Court. The service was in the process of recruiting an additional activity coordinator, as one had recently left.
People told us they had never needed to complain, but they felt confident they could raise any concerns with staff. There was a robust process in place to respond to concerns or complaints by people who used the service, their representative or by staff.
Rating at last inspection:
At our last inspection in August 2018 Loxley Court was rated requires improvement (supplementary report published 30 May 2019) and we found three breaches of regulations. 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 these regulations. However, during our inspection we found a new breach of regulation 12 (Safe care and treatment) and Regulation 17 (Good Governance).
Why we inspected:
This was a planned inspection based on the previous rating.
Follow up:
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.