Foxearth Lodge Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This service provides nursing care. Foxearth Lodge Nursing Home accommodates up to 67 older people. There were two units in the service, Woodlands, where mainly people living with dementia lived and Foxearth Barns, some people also living with dementia lived in this unit which was on two floors.

There were 56 older people, some living with dementia, living in the service when we inspected on 25 and 28 June 2018. This was an unannounced comprehensive inspection.

At our previous inspection of 26 March 2015, this service was rated good overall. At this inspection of 25 and 28 June 2018 the overall rating had deteriorated to requires improvement. We have identified breaches in Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009.

The full version of this report shows what actions we have asked the provider to take.

There was not a registered manager in place. 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.

Since our last inspection there had been management changes with the registered manager who worked at the service during our last inspection de-registering in August 2018 and another registered manager being in place from October 2017 to June 2018. The provider’s and previous registered manager’s systems to assess and monitor the service had not been robust. They had failed to independently identify shortfalls in the service and address them in a timely manner. Records including incidents and accidents, people’s behaviour records and food and fluid records had not been reviewed and analysed to identify trends and reduce future risks to people.

There was a new manager working in the service since 18 June 2018. They were planning to submit an application to the CQC to be registered manager. Since the time the new manager had been in place, they and the provider’s management team had drawn up a service improvement plan, which identified shortfalls in the service and an action plan was in place to address them. The action plan was dated 23 June 2018 and was still in the early stages but the management team were in the process of implementing changes. These needed to be fully implemented and embedded in practice to assess how these benefitted people who lived in the service.

Notifications relating to injury and safeguarding had not been made to CQC as required by law. Since 2016 we had not received any notifications of injury and only one notification of safeguarding in 2017. We reviewed the service’s records and found that there were incidents of injury and safeguarding which we should have been notified of.

Improvements were needed in how the service assesses and mitigates risks to people. This included in people’s care plans and risk assessments and how they guide staff in the reduction of assessed risks.

The systems in place for medicines management were not robust to ensure that they were safe at all times. The new manager had identified shortfalls and an action plan was in place to improve this.

The numbers of staff required to meet people’s needs were calculated. At the time of our inspection we saw that people were provided with assistance when they needed it. We identified an issue with the staff recruitment processes, this was addressed immediately, once we pointed it out.

There were infection control systems in place to red

Foxearth Lodge nursing Home is registered to care for up to 67 elderly frail people, some of whom may be living with Dementia. There were 55 people living in the service when we inspected on 26 March 2015.

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.

People received care that was personalised to them and met their needs and wishes. The atmosphere in the service was friendly and welcoming.

Appropriate recruitment checks on staff were carried out and sufficient numbers employed. Staff had the knowledge and skills to meet people’s needs. People were safe and treated with kindness by the staff. Staff respected people’s privacy and dignity and interacted with people in a caring and compassionate manner.

Staff listened to people and acted on what they said. Staff knew how to recognise and respond to abuse correctly. People were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Staff understood how to minimise risks and provide people with safe care. Care and support was individual and based on the assessed needs of each person. Appropriate arrangements were in place to provide people with their medicines safely.

Staff were well trained and supported through regular supervision and appraisal.

People were encouraged to attend appointments with other healthcare professionals to maintain their health and well-being.

People were encouraged to pursue their hobbies and interests and participated in a variety of personalised meaningful activities.

People voiced their opinions and had their care needs provided for in the way they wanted. Where they lacked capacity, appropriate actions had been taken to ensure decisions were made in the person’s best interests. People knew how to make a complaint and any concerns were acted on promptly and appropriately.

People were provided with a variety of meals and supported to eat and drink sufficiently. People enjoyed the food and were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

There was an open and transparent culture in the service. Staff were aware of the values of the service and understood their roles and responsibilities. The manager and provider planned, assessed and monitored the quality of care consistently. Systems were in place that encouraged feedback from people who used the service, relatives, and visiting professionals and this was used to make continual improvements to the service.