We visited Foxbridge House on the 12th and 13th of August 2014 and considered our inspection findings to answer questions we always ask providers when we visit to inspect a service; is the service caring, responsive, safe, effective and well led.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.