Archived: Loxley Court

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.

We checked progress the registered provider had made following our inspection on 15 May 2017 when we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were Regulation 12, Safe care and treatment; Regulation 18, Staffing; and Regulation 17, Good Governance.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well-led to at least good. During this inspection we found the registered provider was no longer in breach of Regulations 12 and 17. However, we found a further breach of Regulation 18; a breach of Regulation 10, Dignity and respect; and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, Notification of other incidents.

Loxley Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Loxley Court is located on the outskirts of Sheffield. Accommodation is provided over three floors, accessed by a lift. Loxley Court accommodates up to 71 people across four separate units, each of which have separate adapted facilities. 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 55 people living at Loxley Court at the time of this inspection.

There was not a registered manager at the service. The improvement manager had been acting as manager for four weeks at the time of this inspection. 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.

Staff told us there were usually enough staff employed to keep people safe. However, they felt there were too many agency staff employed and this impacted on their ability to meet people’s needs in a timely and effective way.

Staff told us they knew what it meant to treat people with dignity and respect. However, we saw this did not always happen in practice.

CQC had not been notified when a Deprivation of Liberty Safeguard (DoLS) had been authorised for a person living at Loxley Court. These notifications were retrospectively submitted following this inspection.

The design and adaptation of the premises did not fully meet the needs of people living with dementia. We spoke with the deputy manager about this and recommended they consider good practice guidance regarding ‘dementia friendly’ care homes.

The registered provider had recruitment procedures in place to make sure staff had the required skills and were of suitable character and background. We found three instances where these had not been followed. The head of improvement took immediate action to rectify this.

Systems were in place to ensure people were supported by staff who had the knowledge and skills necessary to carry out their roles in meeting people’s needs. Staff were suitably trained. However, staff did not receive regular supervision in line with the registered provider’s own policy and procedure.

Staff were knowledgeable about how to protect people from harm and what they would do if they had any safeguarding concerns. They were confident any concerns would be taken seriously by management.

We saw the premises were clean and well maintained.

Medicines were stored securely and procedures were in place to ensure people received their medicines as prescribed.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People were assisted to maintain their health by being provided with a balanced diet and supported to access a range of health and social care professionals.

People and their relatives told us the staff were kind and caring. We saw positive interactions between people, their relatives and staff throughout this inspection. Most staff knew people and their preferences well.

There were activities available to people living at Loxley Court and additional activity coordinators had recently been employed. This was to ensure every person had the option to be involved in group activities and have 1:1 time.

People’s care records reflected the person’s current health and social care needs. We saw these were evaluated monthly and if there was a change in the person’s circumstances.

There was an up to date complaints policy and procedure and this was displayed in the reception area.

The service had up to date policies and procedures which reflected current legislation and good practice guidance.

Safety and maintenance checks for the premises and equipment were in place and up to date.

Loxley Court had been operating for many years. Indigo Care Services Ltd took over the home and were registered with CQC in September 2016. This is the first inspection since the new providers were registered.

There was 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.

This inspection took place on 15 May 2017 and was unannounced. This meant the people who lived at Loxley Court and the staff who worked there did not know we were coming.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to any incidents to. However, some of the plans of care did not contain sufficient information to protect people from possible harm. We also found some staff were not following the directions given in the plans of care, for example the safe management of diabetes.

We found that there was no system for analysing these incidents and identifying trends or patterns. The registered manager was working on improvements with staff from the local authority's contracts team and the local clinical commissioning group to look at root cause analysis.

Prior to the inspection CQC had a number of notifications that staff had not had access to sufficient personal protective equipment and bedding appropriate for the level and type of care provided. The registered manager told us the budget for these was frequently overspent due to the increase in numbers of people living at the service and the complexity of their needs. However, the registered manager assured us that she always ensured their was sufficient equipment was in place.

Staffing levels were sufficient to meet people's needs. Staff had been received some training and support to provide them with the skills and knowledge to undertake their role. This included a better understanding about how to ensure that they worked within the legal requirements of the Mental Capacity Act (2005). However there was some outstanding mandatory training requirements and further work was needed to ensure that staff understood how to support people who challenge.

The home had a happy, positive atmosphere with friendly interactions between people and staff. Staff knew people well and were able to support them in a caring way. People were supported by staff that showed compassion and empathy.

People said they liked the food and were able to choose what they ate.

Staff knew people well and people told us the staff were caring. People’s privacy and dignity were respected and promoted.

A programme of activities was in place so people were provided with a range of leisure opportunities.

People said they could speak with staff if they had any worries or concerns and they would be listened to.

There were some systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. However, some of these audits were ineffective as risks within the environment had not been identified and minimised.