Loxley Hall

Loxley Hall is a residential care home providing nursing and personal care for up to 40 people. The service provides support to older people with nursing needs. At the time of our inspection there were 36 people using the service in a purpose-built building.

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

People received safe care. Medication systems had been improved and were now safely managed. The oversight of risks faced by people from their health conditions and the environment had been reviewed and were up to date.

People told us they felt safe, and the staff team were very kind to them. This was echoed by relative comments we received. People felt that staff knew their individual preferences and that they were enabled to be as independent as possible.

Staff levels met the needs of people and staff worked to ensure that the needs of people were paramount. The building was clean and hygienic, and this was confirmed through what people told us as well as our observations.

Robust auditing was now in place with a variety of audits being carried out to monitor the quality of care provided at Loxley Hall. People told us they knew who the registered manager was and saw them as approachable and providing a well led service. Relatives commented that the management team were very open and transparent with them and communicated important information to them when necessary. Relatives considered the service to be caring and managed well.

The provider/manager asked all people living in the home, their relatives and staff to comment on the care provided. Staff considered the registered manager to be approachable and had taken time to recognise the efforts of the staff team. An ethos of teamwork had been created within the service and staff commented positively on all aspects of their day to day experiences.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 June 2022) breaches in safe care and governance of the service were identified. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Loxley Hall is a care home providing regulated activities personal and nursing care to up to 40 people. The service provides support to older people. At the time of our inspection there were 35 people using the service.

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

Risk assessments were not always in place to guide staff on how to safely support people with specific health conditions and medicines were not always managed safely. Information regarding some agency staff was not always available and the information provided to agency staff on how to provide people with safe care was not always up to date.

There were a range of audits completed by the provider and manager, however some aspects of the care service needed to be reviewed following this inspection.

Feedback received from relatives was positive regarding the care being delivered to people living in the home. It was observed during the inspection that people were comfortable and happy in the presence of staff who interacted with them in a caring and patient manner.

Systems and processes were in place to safeguard people from the risk of abuse. Relatives told us they felt their loved ones were safe with staff. GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary and in a timely manner.

Accidents, incidents and complaints were managed appropriately and monitored. Infection prevention and control standards were also monitored and managed appropriately. A family member told us “They’ve done really well over Covid.”

Staff were recruited into their roles safely and there were enough staff available to safely meet people's day to day 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.

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 (published 4 September 2019).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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 COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, medicines management and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Relatives felt they had been kept informed throughout the pandemic and spoke highly of the communication they had received. One relative told us “I've had e-mail communication from the manager and the clinical lead about visiting, how it would be managed and what to expect. I've been kept informed about the changes. They've also attached the government guidance to e-mails so you can read that as well."

Relatives spoke positively about their experience of visiting their loved ones and felt the arrangements for visiting were safe. Visits took place in a room that that was cleaned in-between visits and contained a full-length screen and a microphone to aid communication. One person’s relative told us, " We arranged a regular day for me to visit. They asked me what day was the best for me and what time. When I get there, the first thing they do is take my temperature then they open the door and ask me to sanitize my hands. Then they give me a sheet I have to fill in that has questions about Covid. Providing everything's alright I walk around the outside of the building to the room. I have every faith in them and that they are doing everything they can to keep my relative safe."

People were supported to keep in touch with their family using technology. One relative told us their family had daily Skype calls with their loved one and commented, "For us and for my relative these have been a huge success and a bit of a lifeline in terms of keeping in touch."

The environment was clean and hygienic and increased cleaning schedules to reduce the risks of cross infection were in place. We observed staff wearing the correct personal protective equipment (PPE) and they knew how to dispose of it safely. One relative told us, "Staff always wear a mask, I've never seen any staff without a mask on."

People and staff were taking part in regular COVID-19 testing. People were being monitored for symptoms of COVID-19 and people who needed to were supported to isolate in their own rooms. Staff were informed of who was isolating and knew what PPE to wear and what enhanced procedures needed to be followed to protect them from risk. Any visitors needing to enter the building were screened for signs and symptoms of COVID-19, asked to sanitize their hands and provided with PPE before they could enter.

Further information is in the detailed findings below.

The home is registered to provide personal care and nursing care for up to 40 people, however the registered manager told us that the maximum number of people who would be accommodated was 36, and 33 people were living at the home when we visited. This was the first inspection of the home since a change of registration in October 2017.

The home is required to have a registered manager. 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. A new manager was registered in May 2018.

We found there were enough staff to meet people’s support needs. Staff were recruited safely. Training was provided to ensure staff had the knowledge and skills to work safely and effectively. Staff were supported in their role through individual supervisions.

People told us they felt safe in the home and that they had no concerns regarding their care. They told us the staff were kind and caring and protected their dignity and privacy. The premises were clean and adequately maintained and a programme of refurbishment was underway. People’s medicines were managed safely.

Applications to deprive people of their liberty had been made appropriately. Records showed that consent was sought in line with the principles of the Mental Capacity Act 2005.

People were satisfied with their meals and with the choice of food available.

A range of social activities was provided to keep people stimulated and occupied.

Both the home manager and the area manager completed regular quality monitoring audits which identified any areas needing improvement. The management team had ideas and plans to further develop the service.