Saxby Lodge Residential Care Home

Saxby Lodge is a residential care home providing the regulated activity of accommodation with personal care for up to 19 people. People had a range of care needs including frailty of age and people living with dementia. At the time of our inspection there were 13 people using the service. Accommodation was over two floors in one adapted building.

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

There were misunderstandings between the provider, registered manager, and staff about the way the service was managed. This had a negative impact on the culture of the service and how it operated. Governance processes were not effective in identifying some service shortfalls. There was a failure to take appropriate action to keep people safe.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People did not always experience person centred care. There was a lack of activities and opportunities for meaningful engagement and stimulation. People had a limited choice of food or snacks to meet their needs or preferences. People told us they had enough to eat and drink.

People had access to healthcare services and staff engaged with health and social care professionals. People received visitors and relatives told us they were kept up to date with their loved one’s well-being.

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 17 February 2023). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We received concerns that the service was regularly running out of food. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only. 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 remained requires improvement based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the effective section of this full report. People had enough to eat. There was enough food to last until the next food delivery.

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.

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

Enforcement

We have identified breaches in relation to person centred care, protecting people from harm and how the service was managed at this inspection. Please see the action we have told the provider to take at the end of this report.

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

Saxby Lodge Residential Care Home is a residential care home providing accommodation and personal care to up to 19 people. The service provides support to people with a range of care needs including Parkinson's disease, frailty of age and people living with dementia. At the time of our inspection there were 12 people using the service.

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

Risks to people, including environmental risks, had been identified and assessed and were generally managed safely, although maintenance works being undertaken at the home on the day of the inspection had not been appropriately risk assessed. How people’s consent was gained was not formally documented if they lacked capacity, but 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.

People felt safe living at Saxby Lodge Residential Care Home. One person said, “This is a safe place to live. I wouldn’t want to live anywhere else”. People received their medicines as prescribed. Staffing levels were sufficient and people felt there were enough staff on duty to meet their needs promptly. One person said, “I think there are enough staff and they are all good”.

People were happy at the home. One person said, “I know who the manager is and she is very nice. The place is managed well. It’s a homely place. I like it, we are like a family. I have lovely friends here”. People’s diverse needs were catered for.

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 14 October 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at a previous inspection.

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.

We undertook an unannounced comprehensive inspection of the service on 9 August 2021. Breaches of legal requirements were found, and conditions were placed on the provider’s registration in relation to six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

The provider completed an action plan after the inspection on the 9 August 2021 to show how they would improve and by when. We undertook an unannounced comprehensive inspection of the service on 7 February 2022 to check they had followed their action plan. At the inspection on the 7 February 2022 the provider was no longer in breach of regulations. The provider was required to send CQC a monthly report of actions to demonstrate how they were meeting the conditions placed on their registration.

We undertook this focused inspection to check they were meeting the conditions and to confirm they now met legal requirements. The overall rating for the service has remained requires improvement based on the findings of this inspection. Please see the well led section of this report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Saxby Lodge Residential Care Home 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.

Saxby Lodge is a residential care home providing personal care to up to 19 people. The service provides support to people with a range of care needs including Parkinson’s disease, frailty of age and people living with dementia. At the time of our inspection there were 11 people using the service.

Saxby Lodge accommodates 19 people in one adapted building.

People’s experience of using this service

People were not always provided with safe care. Some people’s health and associated risks were not appropriately assessed and planned for. Some care records lacked important detail to guide staff on how to make people safe. Staff practices were not always in line with national guidelines to keep people safe.

There was a lack of robust provider oversight and governance of the service. Aspects of leadership and governance were not effective in identifying some of the concerns found. The service had failed to maintain some of the improvements found at the previous inspections in relation to care planning, risk management and safe working practices. There was a lack of meaningful activities for people and we have made a recommendation about this.

People were happy with the care they received and felt safe with the staff that were supporting them. There were enough staff to ensure people’s needs were met in a timely way. The provider ensured staff were recruited safely. Staff undertook training to ensure they were suitably skilled and knowledgeable for the role.

People had access to healthcare services and staff supported them to attend appointments. Where needed, staff engaged with healthcare professionals to promote good outcomes for people.

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 requires improvement (published 25 February 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at a previous inspection.

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.

We undertook an unannounced comprehensive inspection of the service on 9 August 2021. Breaches of legal requirements were found, and conditions were placed on the providers registration in relation to the following regulations of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014;

Regulation 9 (person centred) care, Regulation 10 (dignity and respect), Regulation 11 (need for consent), Regulation 12 (safe care and treatment), Regulation 14 (meeting nutritional and hydration needs), Regulation 15 (premises and equipment), Regulation 17(good governance), Regulation 18 (staffing). The provider completed an action plan after the inspection on the 9 August 2021 to show how they would improve and by when.

We undertook an unannounced comprehensive inspection of the service on 7 February 2022 to check they had followed their action plan. At the inspection on the 7 February 2022 the provider was no longer in breach of regulations.

The provider was required to send CQC a monthly report of actions to demonstrate how they were meeting the conditions placed on their registration. We undertook this comprehensive inspection to check they were meeting the conditions and to confirm they now met legal requirements.

The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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.

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 the management of the service at this inspection.

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

We have recommended the provider seeks advice from a reputable source about providing meaningful activities for people living in care homes

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.

Saxby Lodge Residential Care Home accommodates up to 19 older people. There were 11 people living with health conditions associated with older age, dementia and frailty at the time of our inspection.

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

People told us they spent most of their time alone in their bedrooms, which we observed. There was very little opportunity for meaningful occupation and stimulation. This is an area of continued required improvement.

Since the last inspection the management team and the staff have made significant improvements which has raised the standard of care people received and the overall governance of the home. Some improvements were still required to ensure the provider was always working in accordance with government and best practice guidance to ensure people consistently received person centred care.

People were protected from avoidable harm as risks to people's health and safety were identified and assessed. People and their relatives told us they felt safe and were cared for by staff who knew them well. Medicines were managed safely, and people received their medicines as prescribed. Accidents, incidents and safeguarding concerns were reported and investigated as required and actions taken to prevent reoccurrence. People were protected from the risk of abuse and staff were aware of their safeguarding duties and how to report concerns. People and their relatives told us staffing levels had improved and there were enough staff with the appropriate skills and training to meet their needs.

People were treated with kindness, dignity and respect. Staff interactions with people were warm and caring. People were observed in a homely environment adapted for their needs and were supported to drink enough and maintain a balanced diet. 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.

The service had a positive culture and embraced continuous learning and improving care. Since the last inspection there has been a change in the management structure of the home with a new manager who came into post October 2021. The nominated individual had taken on a more proactive role in ensuring the service improved, focusing on the development and improvement of people’s risk assessments and care planning to ensure people were supported safely.

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 Inadequate (published 21 December 2021) and there were 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 9 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

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

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

People who lived at the service, and who were dependant on staff for their hydration needs, were at risk from dehydration and increased risk of urinary tract infections (UTI). This was because records of their fluid intake were incorrect and misleading. Some people were at risk of potential weight loss as their nutritional needs were not always being met.

Staff were not trained to meet the needs of people who had specific health and support requirements such as Parkinson’s Disease or required support to eat. Some staff were unaware of people’s underlying health conditions and associated risks. This meant there was a risk that staff could miss the signs that a person’s health was deteriorating and the required action to take.

Information in people’s care records and staff knowledge was not enough to ensure safe care. For example, where people had significant terminal health conditions their care plan’s failed to provide any information to guide staff on the care or treatment they required.

Appropriate action was not always taken to mitigate risks to people. There was a failure to assess and mitigate known risks to people such as those associated with respiratory conditions, the risk of catheter induced infections, changes in blood sugar levels and required action for people with diabetes.

Our observations showed there were not enough staff deployed during the day to provide people with personalised care, meaningful occupation and to keep people safe. A relative told us “I am unhappy with the staffing levels and have commented as such to Saxby Lodge. Because I visit regularly, I recognise staff and am concerned since the new ownership longstanding staff have left. There have been, in the past six weeks, at least five new faces. They seem to be very short staffed at weekends and no sign of any managerial support.”

Environmental risks were not always well managed. We observed some poor practice with environmental safety including a failure to safely control substances that are hazardous to health (COSHH), safe storage of medicines and infection prevention and control.

The service was visibly unclean in places and there was a very strong smell of urine in parts. One person told us it was like living in a urinal and visitors to the service described the small of urine to be overwhelming. This did not make for a pleasant and dignified environment in which to live. Relatives described the environment as shabby with equipment and furnishings that were worn and old. One relative said, “My first visit l was quite shocked to see how shabby and run down the interior of the home was and my first thought was to get her out of there”.

People told us they spent most of their time alone in their bedrooms. There was little opportunity for meaningful occupation and stimulation. People told us they did not use the main lounge as it was not very stimulating, one person said, “I get more company from my TV than I do in the lounge”.

Care plans did not always reflect people's individual preferences for how they wished their care and support to be delivered. Care plans did not clearly identify which aspects of their care people could manage themselves or the type of support people required in order to promote independence.

There was a lack of leadership and oversight of the service. People, staff and relatives consistently told us how they had fed-back concerns and suggestions, but these had not been acted upon. A relative told us, “Saxby Lodge is no longer the home it was. Having given the new owners a reasonable period of time to settle in, and I know change is always difficult for staff, residents and relatives alike, I am considering seeking an alternative placement.”

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible, the policies and systems in the service did not support this practice. People’s liberty may have been deprived without the lawful safeguarding in place to protect their rights.

Some people shared their positive experiences of living at the service. One person told us how good it was to know that there were people around if needed, and that made them feel safe. Another told us staff were kind and a relative said, their loved one had recently moved in and they found the service to be ok, staff were friendly, and they would recommend it to others.

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

Rating at last inspection

This is the first inspection under a new provider since they were registered with CQC in February 2021. The last rating of the service under the previous provider was rated Good ( published in 6 June 2019).

Why we inspected

The inspection was prompted in part due to concerns received about standards of care in relation to insufficient food, drink and insufficient staffing levels and competencies. A decision was made for us to inspect and examine those risks.

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

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 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: risk management, medicines management, safe staffing levels, staff training, ensuring adequate nutrition and hydration, maintenance and cleanliness of the premises, ensuring people received person centred care and support, treating people with dignity and respect, the need for consent ensuring, systems and processes are operated effectively to assess, monitor and improve the quality and safety of the service at this inspection.

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

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 for 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 return to visit to review the improvement made. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.