Loxley Lodge Care Home

Loxley Lodge Care Home is a residential care home providing personal care to 22 people at the time of the inspection, including people living with dementia. The service can support up to 42 people. Loxley Lodge Care Home is purpose built and is split over two floors with communal areas on each floor. The provider had created a specific area, containing some of the bedrooms on the upper floor, which could be used by people who needed to be isolated from the rest of the care home for infection control purposes.

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

People were supported by staff who had access to enough personal protective equipment (PPE). However, some staff did not always wear it correctly. Some cleaning tasks, designed to reduce the risk of health infections spreading, were not always carried out regularly.

People lived in a care home which was generally clean and tidy, and areas of the care home were being refurbished. Arrangements were in place to control visits to the care home and regular COVID-19 testing, of people and staff, was carried out.

People’s care plans were in the process of being reviewed and updated. Although staff understood people’s health needs, some care plans contained contradictory information which still needed correcting. People received regular and consistent support with their care needs and were safely supported to use hoists and other equipment.

People were supported by enough staff to meet their care needs, but the provider did not have all the required employment records for some of the newly employed staff. The provider rectified that after the inspection.

People received their prescribed medicines from staff who were appropriately trained, and medicines were safely managed. People were supported by staff who understood how to safeguard them from the risk of abuse or neglect, and knew how to raise the alarm with other agencies, such as the local authority and CQC, if necessary.

The service had improved since the last inspection. People, relatives and staff all spoke positively about the improvements implemented. The management of the service was more open and accessible, and the provider’s quality assurance processes were more effectively implemented. The manager was continuing to make improvements and acted positively to feedback from other agencies about incidents and issues that arose.

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 2 December 2020) 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

We carried out an unannounced focused inspection of this service on 10 September 2020. Breaches of legal requirements were found, and two Warning Notices were served on the provider in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan, after the last inspection, to show what they would do and by when to improve safe care and treatment and effective governance at the service.

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 of Safe and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection, for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Loxley Lodge Care Home on our website at www.cqc.org.uk.

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.

Loxley Lodge Care Home is a residential care home providing personal care to 37 people at the time of the inspection, including people living with dementia. The service can support up to 42 people. Loxley Lodge Care Home is purpose built and is split over two floors with communal areas on each floor. The provider has created a specific area, containing some of the bedrooms on the upper floor, which is used by people who need to be isolated from the rest of the care home for infection control purposes.

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

People’s care plans did not always accurately reflect their individual risk assessments, and some staff told us they were not always informed about people’s dietary support needs. People didn’t always receive the care they needed in respect of continence support, and they did not always receive safe support to use mobility equipment such as hoists.

People lived in an environment which was not always clean and hygienic; and were supported by staff who did not always follow best practice guidelines on wearing personal protective equipment in order to reduce the risk of spreading infections. People were not always supported by enough staff to meet their care needs, and the provider did not always ensure that recommended improvements in care were effectively and consistently implemented.

People were supported by staff who held mixed views on whether the service met people’s needs. Similarly, feedback from people’s relatives was varied; with some relatives telling us they were very happy with the care their loved one received, and other relatives telling us their loved one did not always receive the support they needed. The people we spoke to told us they liked the staff who supported them.

The provider did not have effective processes in place to monitor and improve the quality of the service provided to people. The provider’s quality monitoring processes had not identified the issues we found on the inspection. Some staff told us they did not feel able to tell the provider about any concerns, and that the provider had told them not to contact CQC.

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 Requires Improvement (published 22 November 2019). This service has been rated Requires Improvement for the previous two consecutive inspections.

Why we inspected

We received concerns in relation to the management of the service, staffing levels, infection control arrangements, and the way people were supported by staff through moving and handling. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No new areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Loxley Lodge Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment of people, staffing levels, hygiene and cleanliness, and the governance systems the provider has in place to ensure the quality of the service provided.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

Loxley Lodge Care Home (Loxley Lodge) is a residential care home registered to provide personal care for up to 42 people in one adapted building. Nursing care is not provided at Loxley Lodge. At the time of the inspection 33 people were living in the service.

The home is registered with the Care Quality Commission to accommodate adults of all ages, including those living with dementia or mental illness and those with physical disabilities.

The environment was not always clean, we found that after areas had been cleaned, cleaners had only worked on surface areas and not underneath equipment which remained soiled.

People’s right to make their own decisions was respected. People were supported to access healthcare services if needed. Staff had appropriate skills and knowledge to deliver care and support in a person-centred way. People were supported to have enough to eat and drink.

Staff referred to people in a respectful manner. People felt that staff were kind and caring and treated them with respect.

Staff respected people’s dignity and privacy and people were supported to be as independent as possible.

Medicines were managed safely and regular audits and checks of medicine management was taking place.

The service was managed by a registered manager who had a clear vision about the quality of care they wanted to provide. Staff were aware of their roles and responsibilities. A range of quality assurance checks were carried out to monitor and improve the standards.

The provider had acknowledged improvements that were required and had put measures in place to make the required improvements. This was being implemented at the time of our inspection and we saw that new processes had been implemented to bring about positive change.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This was a planned inspection based on the rating at the last inspection. We saw some improvements since our last inspection which was carried out on 24 May 2018 and was rated as requires improvement.

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.

The service had a registered manager at the time of our visit. 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 supported by a sufficient amount of staff to meet their needs in a timely way. Improvements were also to ensure sufficient checks were carried out in relation to medicines.

Risks to people’s health and safety resulting from the environment and in relation to specific health conditions had been assessed and mitigated in most instances. Further improvements were made following our feedback. People felt safe and were supported by staff who understood their responsibility to protect people from abuse. Staff were recruited safely and action was taken in relation to accidents and incidents to help prevent a reoccurrence.

People’s needs were assessed before they moved to the home. Staff received appropriate training and support to perform their roles effectively. People were supported to eat and drink enough and to maintain their health and risks associated with people’s nutritional and health needs were responded to. The premises had been adapted to meet the needs of the people. 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 home supported this practice. Although some people did not have specific mental capacity assessments and best interest decisions, the registered manager was in the process of completing these.

People were supported by staff who were kind and caring. Action was taken to relieve people’s distress and ensure they were comfortable. Staff described how they worked to meet people’s specific needs and were aware of their preferences. People were supported to communicate and make choices and people had access to independent advocacy to help them express their views. People could be assured that their privacy and dignity were respected by staff.

People’s care plans were in the process of being updated by the registered manager therefore contained variable amounts of person centred information. Not all of the care plans we viewed contained an accurate description of the person’s current care needs. The registered manager took action to address this following our feedback. It was not always clear how people were involved and planning and reviewing their care. We have made a recommendation about involving people in the production and review of their care plans. People did not always have a specific end of life care plan even when they had expressed their wishes with regards this aspect of care. People were provided with opportunities to make a complaint about their care and these were responded to.

Systems were in place to monitor the quality of the service; however these were not fully effective in identifying areas of improvement. People told us they enjoyed living at Loxley Lodge Care Home and staff told us the culture of the home was open and transparent. People’s feedback was sought in relation to the running of the care home and action was taken to make improvements in relation to this feedback. Staff felt supported by the registered manager and the provider maintained oversight of the service. The provider had complied with conditions of their registration and we had been notified of the events which had occurred at the service with one exception.

This is the first time the service has been rated Requires Improvement.