Foxby Hill Care Home is registered to provide accommodation for up to 47 people requiring nursing or personal care, including older people and people living with dementia. The home is organised into two distinct living areas. On the ground floor, up to 27 people live in Warren Lodge which caters for people with a range of nursing and care needs. On the first floor, up to 20 people live in the Bluebell Suite which is reserved for people living with dementia. The registered provider also operates a day care support service in the same building as the care home, although this type of service is not regulated by the Care Quality Commission (CQC).

We inspected the home on 2 November 2016. The inspection was unannounced. There were 46 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection, the provider had submitted DoLS applications for three people living in the home. The local authority had approved one of these applications and was in the process of assessing the others. Staff at all levels had a good understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Any decisions that staff had made as being in people’s best interests were correctly documented.

The registered manager and her team had worked hard to address the areas for improvement identified at our last inspection in June 2015. Although, on this occasion, we found the need for improvement in the management of people’s medicines, there was no evidence that anyone had come to any harm and, prior to our inspection, senior staff had already picked up most of the issues of concern and were in the process of addressing them.

There were sufficient staff to meet people’s needs and staff worked together in a mutually supportive way. The provider supported staff to undertake their core training requirements and encouraged them to study for advanced qualifications. The registered manager maintained a high profile within the home and provided strong, supportive leadership to her team. Staff were provided with close supervision and shift handover meetings were used effectively to ensure staff were aware of any changes in people's needs.

Staff knew how to recognise and report any concerns to keep people safe from harm. People’s individual risk assessments were reviewed and updated to take account of changes in their needs and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. A range of auditing and monitoring systems was in place to monitor the quality and safety of service provision.

There was a warm, relaxed atmosphere in the home and staff supported people in a kind and friendly way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink that met their individual needs and preferences. A varied programme of activities and events was organised to provide people with stimulation and occupation.

This inspection took place on 18 June 2015 and was unannounced. Foxby Hill provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 47 people who require personal and nursing care. At the time of our inspection there were 47 people living at the home. The home is divided into two units the upstairs unit with 20 beds and the other with 27 beds.

At the time of our inspection there was a registered manager in post. 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.

On the day of our inspection we found that staff interacted well with people and people were cared for safely. People told us that they felt safe and well cared for. When we spoke with staff they were able to tell us about how to keep people safe. The provider had systems and processes in place to keep people safe.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed, and care planned and delivered

to meet those needs. People had access to other healthcare professionals such as a dietician and GP and were supported to eat enough to keep them healthy. People had access to drinks during the day and had choices at mealtimes and where people had special dietary requirements we saw that these were provided for.

Staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered.

Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider did not have a training plan in place and staff had not received regular supervision and appraisal.

We saw that staff obtained people’s consent before providing care to them. People had access to activities and community facilities.

Staff felt able to raise concerns and issues with management. We found relatives were clear about the process for raising concerns and were confident that they would be listened to. However, the complaints process was only available in written format and therefore not everyone was able to access this.

Audits were carried out in some areas and action plans put in place to address any concerns and issues, however these had not picked up some of the issues identified at the inspection, for example the gap in medicine records. Audits were not in place for infection control however the registered manager told us that they were in the process of developing these. It was not clear how regular audits were carried out and the process for feeding back and collating issues. Accidents and incidents were recorded and reviewed to ensure trends and patterns were identified. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.