This inspection was carried out on 8 June 2016 and was unannounced.Foxholes Care Home provides accommodation and personal care for up to 110 older people some of whom live with dementia. At the time of the inspection there were 50 people living at the home. Following our previous inspection of the service in December 2015 we imposed a condition on the provider’s registration to prevent them from admitting any further people to Foxholes Care Home because of the concerns found.
There was a manager in post, who had submitted their application to register, however they were not yet registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.
When we last inspected the service on 15 October 2015 and 4 December 2015 we found it was not meeting the required standards. We found breaches of the Regulations in relation to safe care and treatment, staffing, consent and good governance. At this inspection we found that the provider had made some improvements, however the governance around auditing and identifying and responding to concerns was still not robust enough and further improvements were still required.
Staff obtained people’s consent before providing the day to day care they required. We found that processes to establish if people had lacked capacity for certain decisions were followed in line with the MCA 2005 and where necessary best interest meetings were organised to develop an effective plan of care for people. The manager had submitted Deprivation of Liberty Safeguards (DoLS) applications to the relevant authorities to ensure any restrictions applied to people`s freedom were in line with the current legislation. Some of these applications were still pending an outcome.
People were accommodated in a purpose built environment which was clean and well maintained. Bedrooms were personalised and had en-suite facilities whilst still providing specialist bathroom facilities, several communal areas, dining rooms, an orangery room, a shop, hairdresser room, quiet lounges. People were able to choose where they wanted to spend their time.
At the last inspection we found that people were not always protected from harm, two people developed pressure ulcers whilst they were living at the home. At this inspection we found that staff were knowledgeable about people`s needs and any risks of them developing pressure ulcers. People who required were repositioned regularly and staff followed recommendations from health care professionals when offering care.
Previously when we inspected people told us that they felt their needs were not met safely at all times. They had to wait to use the toilet at times as staff took a long time to answer call bells. This time people told us staff were quick in responding to their needs and call bells were answered in time.
Staff received training and were knowledgeable in how to safeguard people from any risks of abuse. They were able to describe what constitutes abuse and the reporting procedure they would follow to raise their concerns.
When we inspected previously we found that people had not received their medicines according to the prescriber`s instructions, medicines were not managed safely. At this inspection the provider had made significant improvements. People`s medicines were administered by trained staff who had a good understanding of safe medicine management practices. People told us they were seen by their GP regularly and staff were prompt in requesting a GP visit if they were in need. Previously we were told by some people that they could only see their GP if staff agreed with them they needed it.
The provider was monitoring people`s dependency levels and on the day of the inspection we saw senior staff re-deploying care staff to different units where there was a need for extra staff members.
At the last inspection people told us they were concerned about staff leaving the service and the high number of newly employed staff members who had not had the skills, experience and abilities to meet their needs at all times. At this inspection we found that the staff team has stabilized and staff had received training relevant to their roles. Staff had regular supervisions to discuss and review their performance and professional development.
People told us that the standard of food provided at the home was good. We saw that the meals served were hot and that people were regularly offered a choice of drinks. Staff monitored food and fluid intake for people who were at risk of losing weight and involved people`s GP and dieticians in their care to ensure people`s nutritional needs were met. People told us staff were kind and respectful in their approach. We observed staff were knowledgeable about people`s circumstances and the conversations we heard between staff and people suggested they knew each other well.
At the last inspection people expressed mixed views about the opportunities available to pursue their social interests or take part in meaningful activities relevant to their individual needs. People told us this very much improved and they were offered various activities and outings they were satisfied with.
The provider recorded and responded to complaints in timely manner and where appropriate, lessons were learned and shared to staff to promote improvements to the service.
Staff were complimentary about the leadership of the home and they felt well supported in their role. They praised the commitment shown by the provider to improve the service and the attitude and availability of the newly employed manager.