Archived: Saxby Lodge Residential Care Home

We carried out an unannounced comprehensive inspection of Saxby Lodge on 29 and 30 April 2019. Saxby Lodge is a ‘care home’ that provides care for a maximum of 19 older people, some of whom of living with dementia. At the time of the inspection 19 people were using the service.

People’s experience of using this service:

The management team and staff knew people well and understood their likes and preferences and health needs. Staff were caring and spent time chatting with people as they moved around the service. Relatives told us they were welcome at any time and any concerns were listened and responded to.

People, professionals, relatives and staff told us the service was very well managed. Staff showed a true fondness for the people they cared for and there was a warm, friendly and welcoming atmosphere. One person said; “I don’t think there’s anything they could do better here.”

People were supported by a staff team that were both caring and compassionate and treated them with dignity and respect. People received person centred care and support based on their individual needs and preferences. Staff knew about people's life history, and their communication needs.

Risks of abuse to people were minimised because staff demonstrated a good awareness of each person's safety needs and how to minimise risks of abuse for them. The environment was safe, and regular health and safety checks were carried out.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for social interaction and activity with staff.

People’s health had improved because staff promoted healthy active lifestyles. They worked in partnership with a range of healthcare professionals and followed their advice.

People were supported in the least restrictive way possible; the policies, systems and culture in the service supported this practice.

People's concerns and complaints were listened and responded to. Accidents, incidents and complaints were used as opportunities to learn and improve the service.

People gave us positive feedback about the quality of care being delivered. They said the management team and members of staff were approachable, listened and acted on feedback.

Rating at last inspection: Good. (last report published 19 December 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection, the service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

For the purpose of this report, we refer to Saxby Lodge Residential Care Home, as Saxby Lodge. Saxby Lodge is a large, detached, older style property situated close to the town centre of Bognor Regis. It is registered to provide accommodation and care for up to 19 older people living with dementia and, at the time of our inspection, was fully occupied. Rooms were of single occupancy. Communal areas included a large sitting room, adjacent to the dining area. The large sitting room had access to a conservatory overlooking an accessible garden to the rear of the property. There was also a sitting area on the first floor of the home.

The service has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The registered manager was not available on the day of our inspection.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff had received an overview of the MCA as part of their dementia training and our observations confirmed staff promoted choice and acted in accordance with people's wishes. However, not all staff demonstrated a clear knowledge of the MCA and DoLS in our discussions with them. We fed back to the registered manager that staff would benefit from further training. The registered manager contacted us the day after the inspection, who told us they had arranged for additional training specifically on the MCA and DoLS to be provided by the end of November 2016. The registered manager also told us, she had purchased MCA information cards for all staff to carry on them, to refresh their knowledge.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People told us they felt safe at the home.

Systems were in place to identify risks and protect people from harm. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required.

Accidents and incidents were accurately recorded and were assessed to identify patterns and triggers. Records were detailed and referred to actions taken following accidents and incidents.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

There were sufficient staff to meet people's needs and keep them safe. The registered manager used a dependency tool to determine staffing levels. This information was reviewed following falls or changes in a person’s health condition, which might increase, or change people's dependency level.

Safe staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

Staff had received a range of training and many had achieved a National Vocational Qualification in Health and Social Care. Staff attended supervision meetings with the registered manager approximately every two to three months.

People had sufficient to eat and drink and were offered a choice throughout the day. They had access to a range of healthcare professionals and services.

The home had been decorated and arranged in a way that supported people living with dementia, although a menu display board did not include pictures or photos of food, which could help to aid people's understanding.

Staff were caring, knew people well, and treated people in a dignified and respectful way. Staff acknowledged people's privacy and had developed positive working relationships with people. Relatives spoke positively about the staff at Saxby Lodge Residential Care Home.

Care plans provided staff with detailed and comprehensive information about people, their likes, dislikes, preferences and how they wanted to be cared for. A range of activities was planned that met people's interests and hobbies. People had access to the community, supported by staff.

Complaints were listened to and managed in line with the provider's policy. Four complaints had been recorded within the last year and all had been resolved to the satisfaction of the person.

People and their relatives were involved in developing the service through meetings and staff were also asked for their feedback in annual surveys. Staff felt the registered manager was supportive and said there was an open door policy. Relatives spoke positively about the care their family members received. A range of audits was in place to measure and monitor the quality of care delivery and to identify any areas for improvement.

If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

In the service safe?

We looked around the building which was clean and free of unpleasant odours. The home involved appropriate professionals in the relation to people's care and regularly monitored people's weight and nutritional needs. One person told us that, 'The staff always help and pop in for chats. I can't fault it, not at all'.

The home had emergency evacuation plans in place and staff we spoke with were able to tell us the emergency evacuation procedures for the home. Medication was stored securely with medicines handled and recorded appropriately. All the staff completed the homes core training programme annually.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. Speaking with staff it was evident that they understood individuals care and support needs. Care plans were in place and they had been signed by the individuals or their relatives.

Is the service caring?

We saw staff treat people in a sensitive, respectful and professional manner. One person told us that they 'need help to get up, with getting dressed and with my personal care' and that they were 'very happy' with the way staff supported them. We spoke with two General Practioners (GP). One GP told us that they were, 'Very impressed with the home and that communication and care was good'. Another GP told us that, 'The staff always do what is required and they couldn't fault the home'.

Is the service responsive?

The care plans and risk assessments were regularly reviewed by the registered manager. The registered manager told us that during the staff handover that all the individuals were discussed which ensured that staff were updated about the support that they had received and any changes were updated in the daily notes. Records confirmed people's preferences, likes and dislikes. The homes routines were flexible to suit the needs of individuals and people confirmed that they got up and went to bed when they wanted to.

Is the service well-led?

We saw that people, their relatives and visiting professional's had been asked for their feedback on the home. Where concerns had been raised we saw that these had been addressed. Staff told us they felt supported and would raise any concerns with the registered manager.

People also told us that they were happy with the environment that they lived in and the levels of cleanliness at the service. For example, one person told us, "It's very clean here. Once a month they do a big clean of my room and the place always smells nice".

We also gathered evidence of people's experiences of the service by observing how people were supported by staff, looking at records and talking with a member of staff and the registered providers. We found that people's care needs were being managed safely by the service and that staff had a good understanding of their roles and responsibilities in this area. When we spent time observing the interactions between staff and people who used the service we found this to be positive, friendly and caring.

Systems were in place that monitored the quality of service people received and considered their views. People told us that their views and opinions were sought on a regular basis and acted upon. We also found that recruitment practices provided protection to people who lived at the service.

We found that people's care was based on individual needs assessments and planned and delivered to ensure their safety and welfare. A person told us "they (staff) know what I need, and they help me to do what I can". We found that staff demonstrated a good understanding of people's needs and preferences.

Records showed that people's medicines were safely managed. We saw evidence that staff were appropriately trained and assessed as competent to administer medicines.

People we spoke to were satisfied with the care they received from staff. A person told us "staff are very good and they do their level best to help people". We found that staff were supported and trained to deliver care and treatment safely and to a good standard.

We found that the provider had an effective system in place to monitor and maintain the safety of the service. However, we found that the provider did not have a system for monitoring and assessing the quality of the service which regularly took into account the views of people and their representatives.

Although we found that staff communicated important information to promote people's safety and wellbeing, we have asked the provider to improve the completion of some records. This is to ensure that information is available to protect people from unsafe care and treatment.