We carried out a review of the data available to us about Foxbridge House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Foxbridge House, you can give feedback on this service.
Foxbridge House is a care home providing personal and nursing care to people aged 65 and over. At the time of our inspection 55 people were using the service. The care home can support and accommodate up to 84 people across four separate wings, each of which has separate adapted facilities.
People’s experience of using this service and what we found
Staff had received training in safeguarding adults and knew the actions to take to protect people from abuse. Risks to people were managed effectively to reduce harm to them. Lessons were learned from incidents and accidents. There were enough staff available to deliver safe support to people in a safe way. People’s medicines were administered and managed safely. Staff followed infection control procedures to reduce risks of infection.
People received support to meet their individual needs. People’s care plans were reviewed and updated regularly to reflect their current needs. People and their relatives were involved in planning their care and they were informed of any changes. Staff supported people to keep in contact and maintain relationships which mattered to them. Staff engaged people as much as possible to reduce the risk of social isolation. People had end of life care plans in place.
There was a complaints procedure available. People and their relatives knew how to complain if they were unhappy with the service. The registered manager addressed complaints received in line with their complaint’s procedure.
The quality of the service was regularly checked, and actions were put in place to drive improvement. The provider worked in partnership with other organisations to develop the service. The registered manager met their statutory responsibilities to the 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 Good (2 February 2019)
Why we inspected
We received concerns in relation to people’s care and welfare and safeguarding allegations. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.
We reviewed the information we held about the service. No 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 Good. This is based on the findings at this inspection.
We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, responsive and well-led domains sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Foxbridge House 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.
Why we inspected
We undertook this targeted inspection to check on a specific concern we had about staff not having access to the correct personal protective equipment [PPE], cleaning was not being completed correctly and staff were not following government guidance on socially distancing. The overall rating for the service has not changed following this targeted inspection and remains good.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
We found the following examples of good practice.
The provider had appropriate arrangements in place to help prevent the spread of Covid 19. They ensured that all staff received appropriate training and support to manage Covid 19. All staff had received training on Covid 19, infection control and the use of Personal Protective Equipment (PPE). We observed staff wearing appropriate PPE and socially distancing throughout our visit. We saw the home was clean and hygienic throughout.
All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home. They were supported to follow the Governments Guidance on wearing PPE and social distancing.
The provider ensured that people using the service could maintain links with family members and friends. People were supported to have visits from their relatives and friends in a designated visiting room where social distancing was observed. Visits were booked in advance and the room was cleaned between visits.
The provider had appropriate arrangements to test people and staff for Covid 19 and was following government guidance on testing. There was a designated team of nursing staff that carried all testing on people using the service and staff. This ensured that people and staff were tested for Covid 19 in a consistent way. Black, Asian and Minority Ethnic Covid 19 risk assessments were carried out with people using the service and staff to ensure they could live and work safely at the home.
The service had a registered manager in post. 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.
At our last inspection in August 2016, the service was rated ‘Good’. At this inspection we found the service continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. We found the service remained ‘Good’.
People continued to be supported and protected from the risk of abuse or harm. Risks to people were assessed and managed to ensure their well-being. Accidents and incidents were recorded, managed and monitored safely to assist in reducing the risk of reoccurrence. There were systems in place to deal with emergencies and protect people from the risk of infections. Medicines were stored, managed and administered safely. There were sufficient numbers of staff to ensure people were supported appropriately and promptly when required. There were safe recruitment practices in place and appropriate recruitment checks were conducted before staff started work to ensure they were suitable to be employed in a social care environment.
Staff received an induction and had on-going support, supervision and training. 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. People were supported to meet their nutrition and hydration needs and had access to health and social care professionals when required.
People told us they were consulted about their care and staff treated them with kindness and respect. Care plans and assessments considered the support people required with regard to any protected characteristics they had under the Equality Act 2010. People were involved in day to day decisions about their care and treatment.
People were supported to participate in activities that were meaningful to them and that met their need for social interaction and stimulation. The registered manager and staff were committed in ensuring people received appropriate support and care at the end of their lives. The home had a complaints policy and procedure in place which contained guidance for people and their relatives or visitors on what they could expect if they made a complaint.
Staff told us the registered manager provided them with leadership and support. There were systems in place that ensured the registered manager and provider took account of the views of people living at the home and their relatives where appropriate. The service worked well with external organisations including health and social care professionals to ensure people’s needs were safely met and to help improve the quality of the service provided. The provider recognised the importance of regularly monitoring the quality of the service and there were systems in place to ensure audits and checks were conducted.
Foxbridge House provides residential and nursing care for up to 84 older people. The home is located in Orpington Kent and is a large purpose-built care home. At the time of our inspection there were 64 people living at the home and there was a registered manager in post. 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.
Risks to the health and safety of people using the service were identified, assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies. There were safeguarding adult’s policies and procedures in place to protect people from possible abuse and harm. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff were deployed throughout the home to meet people’s needs.
There were processes in place to ensure staff new to the home were inducted into the service appropriately. Staff received training, supervision and appraisals that enabled them to fulfil their roles effectively and meet people’s needs. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.
People were treated with respect and were consulted about their care and support needs. Staff respected people’s dignity and privacy. People were supported to maintain relationships with relatives and friends. People’s support needs and risks were identified, assessed and documented within their care plan. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people’s needs were met.
There were systems and processes in place to monitor and evaluate the service provided. People’s views about the service were sought and considered through residents meetings and satisfaction surveys.
This inspection took place on 24 and 25 September 2015 and was unannounced. Foxbridge House provides residential and nursing care for up to 84 older people. The home is located in Orpington Kent and is a large purpose-built care home. At the time of our inspection there were 54 people living at the home and there was a registered manager in post. 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.
We had previously carried out an unannounced comprehensive inspection of the service on 9 and 10 March 2015 when we found nine breaches of the Health and Social Care Act 2008. Breaches found at the inspection in March 2015 included risks to people were not always assessed and managed appropriately, staff recruitment processes were not safe, staffing levels were not always adequate to meet people’s needs, processes were not in place to assess people’s capacity to make decisions in line with the Mental Capacity Act 2005 (MCA 2005), records were not always accurate and contemporaneous and the provider did not have effective systems in place to regularly assess and monitor the quality of service. We served the provider with three warning notices and conducted a focused inspection on 24 June 2015 to check that the warning notices we severed at the March inspection had been met. The provider sent us an action plan detailing the action they would take to meet the other outstanding legal requirements.
We carried out this inspection to check the action plan had been completed and outstanding breaches had been met and also to provide a review of the rating for the service. Following the inspection in March 2015 the provider imposed a voluntary suspension of new placements until actions were taken to address the concerns and breaches we found. The provider lifted the voluntary suspension after our inspection in June 2015 when we had identified that the provider had met the three warning notices we had served.
At this inspection we found that improvements had been made, however we were unable to assess the full effectiveness of some of the systems and processes that were implemented to address the areas of concern as these had not been applied consistently over time. For example the implementation and completion of action plans developed to address areas of concern as a result of audits conducted.
There were sufficient numbers of suitably qualified and skilled staff deployed throughout the home to meet people’s needs appropriately. There were safe and robust staff recruitment procedures in place to ensure staff were suitable for their roles.
Medicines were stored and administered safely, however medicine training records showed that some staff had not completed the provider’s medicines foundation training. We were told that training had been booked for the end of the month. Risks to the health and safety of people using the service were identified, assessed and reviewed in line with the provider’s policy.
There were arrangements in place to deal with foreseeable emergencies. There were safeguarding adult’s policies and procedures in place to ensure that people using the service were kept safe. Incidents and accidents involving the safety of people using the service were recorded and acted on appropriately. Systems and process were in place to regularly monitor the safety of premises and equipment used within the home.
People told us they were involved in the decisions about their care and were able to voice their preferences to staff. Staff demonstrated a clear understanding of the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). Care plans contained mental capacity assessments where appropriate and applications for DoLS were made in accordance with the MCA 2005. The MCA 2005 protects people who may lack capacity to make decisions in relation to consent or refusal of care and treatment. DoLS protects people when they are being cared for or treated in ways that deprives them of their liberty for their own safety.
People’s nutritional needs and preferences were met and nutritional needs assessments and swallowing risk assessments had been completed and were contained within people’s care plans where appropriate.
Staff received an induction into the home before they started work and regular up to date training, frequent and appropriate support, supervision and appraisals which enabled them to carry out their duties.
People had access to health and social care professionals when required. Care plans and records demonstrated that people were involved in making decisions about their care and lifestyle choices and people’s preferences and end of life care needs were assessed and reviewed in line with the provider’s policy.
Staff were knowledgeable about people’s needs and preferences and how to maintain people’s privacy and dignity. We observed staff treating people in a respectful and dignified manner. People were assessed to receive care and treatment that met their needs and care plans were reviewed on a regular basis to ensure this. Care plans were organised and easy to read and care plans and records stored on the home’s computer system were easy to access.
The home provided a range of activities that met people’s needs and reflected their interests. People and their relatives told us they were aware of how to raise a concern and felt confident there concerns would be listened to.
There was a registered manager in post at the time of our inspection and people and their relatives told us the registered manager had made many improvements to the home since our last inspection and they thought the home was well led. There were systems in place to monitor the quality of the service provided and we saw recent internal and external quality assurance audits that were conducted for all areas of care and services provided. Accurate and contemporaneous records were kept and maintained both on the home’s computer system and in people’s paper files in relation to the care and treatment people received. There were processes in place to ensure people, their relatives and staff were provided with opportunities to provide feedback about the service.
We carried out an unannounced inspection of this service on 9 and 10 March 2015 at which breaches of legal requirements were found. We took enforcement action and served three warning notices on the provider in respect of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to people were not always assessed, documented or managed appropriately. We found people were not cared for or supported by staff that were appropriately supported and trained to deliver care and treatment safely and recruitment processes were not safe.
We undertook this focused inspection to check that the provider now met legal requirements. This report only covers our findings in relation to those regulations. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Foxbridge House on our website at www.cqc.org.uk.
Foxbridge House provides residential and nursing care for up to 84 older people. The home is located in Orpington Kent and is a large purpose-built care home. At the time of our inspection there were 56 people living at the home. The provider had temporarily suspended admissions into the home and there was an embargo in place from the local authority.
At this focused inspection on the 24 June 2015 we found that the provider had addressed the breaches of Regulations 12, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and were complaint with the warning notices we served. However the ratings for the service at this inspection remains unchanged as there are other breaches in the key questions Safe and Effective that will be followed up at our next comprehensive inspection of the service.
The inspection took place on the 9 and 10 of March 2015 and was unannounced. At our previous inspection on 12 August 2014 we found the service was breaching several legal requirements. The provider sent us an action plan detailing the action they would take to meet these legal requirements by the 31 December 2014. We carried out this inspection to check the action plan had been completed and to provide a rating for the service.
You can read the report from our last inspection, by selecting the 'all reports' link for ‘Foxbridge House’ on our website at www.cqc.org.uk.
There was no registered manager in post at the time of our inspection, however a new manager was in post and was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.
Foxbridge House provides residential and nursing care for up to 84 older people. The home is located in Orpington Kent and is a large purpose-built care home. At the time of our inspection there were 61 people living at the home.
During our comprehensive inspection we found that the provider had continued to breach several legal requirements. You can see what action we have told the provider to take at the back of the full version of this report.
Risks to people were not always assessed, documented or managed appropriately. People’s malnutrition risk assessments were not completed accurately. Errors were also found in people’s weight records.
Risks relating to pressure wounds were not always assessed, monitored and managed appropriately. People’s pain management was not monitored to ensure people received the care and treatment required.
People at risk of falls were not assessed and monitored appropriately so the provider could take action to reduce the risk of further incidents.
Recruitment processes were not safe and did not protect people from the risk of unsuitable staff being employed by the service.
Staffing levels were not always enough to meet people’s needs. People had to wait to be supported by staff as staff were busy assisting others. Staffing shortages were identified as a problem by permanent members of staff and we saw gaps in staffing rotas. People were not cared for or supported by staff who were appropriately supported to deliver care and treatment safely and to an appropriate standard.
Deprivation of Liberty Safeguards (DoLS) were completed by the local authority ensuring that people’s freedom was not unduly restricted and where restrictions were in place for people’s safety there were records to evidence this was done. However, there were no processes in place to assess and consider people’s capacity and rights to make decisions about their care and treatment where appropriate and to establish best interests in line with the Mental Capacity Act 2005 (MCA 2005).
Records were not always accurate. People's care was not always assessed and reviewed in response to people’s needs. People who were living with dementia did not have detailed care plans that reflected their life histories and social interests. Care plans showed little detail about people’s likes and dislikes in relation to social interaction skills and activities and people were not involved in making decisions about their own care and lifestyle choices. There were no effective systems in place to assess and record people’s end of life care needs and wishes.
The provider did not have an effective system in place to regularly assess and monitor the quality of service people received or the improvements required or actioned as a result of surveys and audits conducted. People, their relatives, staff and visiting professionals to the home told us of the instability in management at the home and how this had a negative impact on the quality of care provided.
There were appropriate medicines policies and procedures in place and we saw that medicines were managed and handled appropriately. Safeguarding adults from abuse policies and procedures were in place to protect people using the service from the risks of abuse.
There were systems in place to deal with foreseeable emergencies and we saw that equipment and systems in relation to the premises were maintained and checked regularly.
People were supported appropriately to eat and drink sufficient quantities to maintain a balanced diet and ensure well-being.
Staff responded to people sensitively when offering support. People told us that staff respected their privacy and dignity.
The home provided a range of activities that people could choose to engage in. People we spoke with told us they enjoyed some of the activities on offer at the home.
People’s concerns and complaints were responded to and addressed appropriately.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and visiting relatives, speaking with visiting professionals and staff and from examining records. If you want to see the detailed evidence supporting our summary please read the full report.
At the time of our inspection there were 78 people residing at Foxbridge House. We used different methods to help us understand the experiences of people who use the service as not everyone who lived at the home was able to communicate verbally with us in a significant way. We used our Short Observational Framework for Inspection (SOFI).
Is the service caring?
We spoke with fifteen people using the service who lived on different floors within the home. Generally people we spoke with commented positively about the care and support they received. One person told us 'The staff are very nice, they look after me well'. Another person said 'I like living here, the staff are good, the food is great and there is always something to do'.
People's needs were not always assessed appropriately and care and treatment was not always planned and delivered in line with their individual care plans. We looked at the care plans and care records for fifteen people using the service. We saw care plans and care records had some elements relating to the care and welfare of individuals; however information was variable and lacked detail and clarity.
There were limited systems in place to ensure that people who used the service received enough information about the care and support provided and to make an informed choice about the care being provided. The provider had a 'Residential care service policy' in place which detailed expected practice by staff in order to comply with the Health and Social Care Act 2008. This highlighted the principles of good record keeping and detailed the care planning formats expected to be in place. However the majority of paper file care plans/records we looked at did not contain a copy of the providers 'care file index', 'admission checklist', 'pre admission assessment and information' and 'life story'. The provider had no systems in place to ensure that people using the service were involved in their assessment/care plan process nor did they have a service user agreement/consent form which people could sign in agreement to their care.
Is the service responsive?
We observed call bells were placed in peoples bedrooms within reach so they could call for support when required. The home used an electronic call bell system which displayed information on monitors throughout the home. At the time of our inspection we noted that one of the monitors was not working correctly. We spoke with the regional manager who advised that the fault had been logged and would be repaired soon.
Access to care records recorded on the computer system was slow and difficult due to technical issues at the time of our inspection. Members of staff we spoke with told us that the computer system was frequently faulty or slow, which was why they also used paper files. When comparing the information recorded and stored within paper files against those held on the computer system it was apparent that people's care plans/records were not kept up to date and were not consistent in content between the systems. This meant that staff may not be fully aware of people's current needs and care support provided may not be appropriate to meet their identified needs.
Is the service safe?
The provider had not responded appropriately to allegations of abuse. During our inspection, we were informed of a safeguarding matter, in that a concern had been raised. This is where one or more person's health, wellbeing or human rights may not have been properly protected and they may have suffered harm, abuse or neglect as a result. Discussions we had with the regional manager revealed that appropriate action had not been taken to immediately notify the relevant external agencies about the incident.
Medication was not always administered as it had been prescribed. We saw that one person was prescribed blister packs of medication which was provided by the pharmacist and contained four weeks supply of tablets. We saw that for week one, two tablets were still in the blister pack although the MAR chart and controlled drugs record had been signed by staff to show that these tablets had been given.
Is the service effective?
People's diversity, values and human rights were not always considered or respected. Paper and computer based care plans/records we looked at were not person centred and did not include detailed information on people's personal histories and people's interests and preferences regarding their daily lives. There was little recorded information about people's religious and cultural needs and due regard to people's age, sexual orientation, linguistic background, racial origin and how staff supported or respected people in relation to this. This meant that people's individuality and diversity was not always considered or respected.
Staff were not appropriately supported to deliver care and support to an appropriate standard. We spoke with staff about their supervision and annual appraisals. Staff felt supported by senior members of the staffing team but they were unable to confirm they had regular formal supervision. One member of staff told us 'We work as a team, everyone supports each other'. Another person told us 'I can't remember when I last had supervision but we do have team meetings'. We looked at the home's supervision policy which stated supervision was approximately every two months (six annually) and appraisals were on an annual basis. We looked at the personnel and supervision files of six members of staff. We saw that two members of staff had not received formal supervision at all and four members of staff had not received supervision for some time, the last being recorded in November 2013. We also noted that of the six staff files we looked at only one member of staff had a completed annual appraisal. This meant that although staff felt supported they were not receiving formal supervision or annual appraisals in accordance with the provider's supervision policy.
Is the service well-led?
People who use the service were asked for their views about the care and treatment provided and they were acted on. People we spoke with were aware of the home's complaints procedure and said they knew they could speak with a member of staff or the manager if they had any concerns. One person told us 'Generally things are very good here, however if there are any issues I have I always tell the staff'. Another person said 'There have been a few problems I've had but they were sorted once I told the staff'. The service had a clear procedure for dealing with complaints and a whistle blowing policy that staff were aware of.
We saw that the home had a system in place to monitor and ensure that it was meeting people's needs. The regional manager showed us the 'satisfaction survey' the home conducts on an annual basis. Resident and relatives satisfaction surveys were completed by people who use the service and family members and or representatives. We looked at the results for the 2013 relative's satisfaction survey conducted by the provider. The results were generally positive.
We found that people were involved in making decisions about their care and treatment. People's care and support needs were assessed and regularly reviewed. Staff understood people's care needs and knew how to protect them from risk and harm. We saw there was enough qualified, skilled and experienced staff to meet people's needs. There was evidence that quality monitoring audits had taken place on a regular basis, and that learning from the audits had taken place and necessary changes were implemented. People's records were kept securely and could be located promptly when needed.