The inspection took place on 22 September 2018 and was unannounced.

Foxes Moon Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Foxes Moon Residential Home is registered to accommodate 31 older people living with dementia and mobility difficulties. There are two floors with the first floor having access via stairs or a lift. There was a quiet lounge and a large dining room which led out into the secure gardens. There was ramp access to the gardens and various patio and lawn areas. There were 30 people living at the home at time of inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and the who to report this to if abuse was suspected.

Staffing levels were adequate to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults.

When people were at risk staff had access to assessments and understood the actions needed to minimise avoidable harm.

Medicines were administered and managed safely by trained and competent staff. Medication stock checks took place together with routine audits to ensure safety with medicines.

People and their relatives had been involved in assessments of care needs and had their choices and wishes respected including access to healthcare when required. The service worked well with professionals such as doctors, occupational therapists and social workers.

People had their eating and drinking needs understood and were being met. People were happy with the quality, variety and quantity of the food.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered manager actively sought to work in partnership with other organisations to improve outcomes for people using the service.

Care and support was provided by staff who had received an induction and continual learning that enabled them to carry out their role effectively. Staff felt supported and confident in their work.

People, their relatives and professionals described the staff as caring, kind and warm.

People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories were detailed and relatives had been consulted.

The home had an effective complaints process and people were aware of it and knew how to make a complaint. The service actively encouraged feedback from people.

People’s end of life needs were assessed and detailed. The records showed that people and their relatives had been involved in these plans. Feedback received by the service showed that end of life care provided was of a good standard.

Activities were provided and these included staff, people and their relatives. Individual activities were provided for those that preferred them.

Relatives and professionals had confidence in the service. The home had an open and positive culture that encouraged the involvement of everyone.

Leadership was visible within the home. Staff spoke positively about the management team and felt supported.

There were effective quality assurance and auditing processes in place and they contributed to service impr

This inspection took place on 14 March 2016 and was unannounced. The inspection continued on 16 March.

Our last inspection on 7 and 8 May 2014 found that meal times did not meet the needs of people with dementia and plans to keep people safe when they ate and drank were not being followed. We asked the provider to take action. During this inspection we found that improvements had been made.

The service was registered to provide personal care with accommodation for up to 31 people. The service has 21 en-suite bedrooms some with walk in showers and others with baths. There is also an assisted bath on both the ground and first floor. The service has a large open plan communal lounge and dining area that people are free to use at any time. The dining area overlooks a patio area which leads into a level access garden. The accommodation is over two floors and the first floor can be accessed by stairs or a passenger lift. There was a laundry room, quiet lounge on the first floor and a fully equipped hairdressing area.

The service had not made statutory notifications to us as required. A notification is the action that a provider is legally bound to take to tell us about any changes to their regulated services or incidents that have taken place in them. We were informed by the owner that the registered manager had left the home in October 2015. We had not been notified of this and the registered manager had not submitted an application to cancel their registration.The owner said that the registered manager had told them that this had been done and told us that they will process this and apply to be the registered manager for the service.

Some environmental risk assessments were not in place. We discussed this with the deputy and manager who following the inspection completed a number of these and sent them to us.

Medicines were not always managed safely. On day two of our inspection we arrived and found the medicine trolley left in the communal lounge unattended with the key in it. We spoke to the staff member who told us it was not common practice for them to leave a key in the trolley. We discussed this with the manager and deputy who said this will be looked into.

Medicines were only given by staff that were trained to give medicines. We saw staff waited with a person while they took their medicine and offered a drink. Medicines were signed as given on the Medicine Administration Records (MAR) and were absent from there pharmacy packaging which indicated they had been given as prescribed.

People and relatives told us they felt the service was a safe place to live. Staff were able to tell us how they would recognise signs of abuse and who to report any concerns to. There was also an up-to-date safeguarding policy in place and records showed that staff had received training in this.

Staff and relatives told us they felt there were enough staff in place to deliver care and support to people who lived there. The manager and deputy both worked care shifts and offered support to staff on a daily basis. Additional staff were provided when people were supported away from the home. Recruitment took place safely.

Staff were knowledgeable of people’s needs and received regular training which related to their roles and responsibilities. We reviewed the training records which confirmed that the majority of staff had received training in topics such as moving and handling, safeguarding, food hygiene and medicines. Staff were also supported to complete their diplomas in health and social care. A staff member said, “I am well trained to carry out my role. I have signed up to complete my level three diploma”.

Staff were aware of the Mental Capacity Act and told us they had received Mental Capacity training. The training record we reviewed confirmed this. We reviewed capacity assessments and best interest meeting records which clearly identified why decisions were made and the people who were involved for example the GP and relative

Staff were supportive and kind. We observed staff supporting people with their mobility. Staff also supported people who were unsure of the time and where they were.

We spoke with staff who told us that it was busy but there was time to spend with people. We spoke with a relative who told us that whenever they visited there were always staff around who were helpful and caring.

The home accommodated 26 people at the time of inspection.

People were treated with consideration and respect. One person told us, “The staff are nice, thoughtful people.” Another person said, “They are very kind and helpful.”

Peoples care needs were assessed and care was planned and delivered to meet people’s needs. One person’s relative said, “I have never found mum looking untidy, she is cared for very well.” People’s medicine was managed safely. One person told us, “They do my medication, but I check it and invariably it is correct. They come at the right time, more or less.”

People were cared for in a clean environment. One person told us, “I have no fault to find with the cleanliness.” Staff were aware of how to minimise the risk of cross infection.

Staff were appropriately trained and supervised and felt supported to do their jobs.

The provider monitored the quality of the service and sought people’s views and experiences. One person told us, “The owner asks if everything is ok and if there is anything else they could do. I feel able to make suggestions.”

Accurate records in relation to people’s care were maintained.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us their experiences.

People's privacy and dignity were respected. One person’s relative told us “Staff are very respectful from what I have seen”.Bedroom and bathroom doors were kept closed when people were being assisted with personal care. One person told us they had their own room key.

People told us that they were provided with the support they needed. One person told us “The staff are very good they give you all the help you need”. However, we found that people's care was not always delivered according to their care plans.

The home was clean at the time of inspection. One person told us “It’s very clean here, they are pretty good at that”. However, the provider did not have policies and procedures to guide staff in infection prevention and control.

At our previous inspection we had asked the provider to make some improvements in relation to their refrigerated storage of medicines. We found that these improvements had not been made and medicines were being stored above the correct temperature.

The provider operated effective recruitment procedures and conducted all the necessary check prior to staff starting work.

The provider did not keep accurate records in relation to peoples care and the running of the service.

The majority of the people at the home were suffering from dementia and not many were able to tell us about their experiences or their views. We spoke with three people living at the home and several relatives.

People, who were able to talk with us, told us that they received very good care and that they felt safe and supported at the home. They told us that there was one main choice of meal at lunchtime but that staff always got them something else if they didn’t like what was on offer.

Two people were able to tell us that staff brought their medicines to them regularly and explained the medicines to them if they asked.

We observed that staff spoke to people in a sensitive and respectful manner. The providers, registered manager and staff were skilled in communicating with, and in responding to the needs of, people with dementia. They responded well to any signs of agitation or anxiety shown by people at the home and were able to provide adequate reassurance .

The lounge was divided into distinct areas and groupings of chairs and people were encouraged to choose where they sat. Several preferred the television area or sitting over looking the garden. There had been adaptations to the décor in some communal areas of the home, which facilitated reminiscence and enhanced the experience of people suffering from dementia.

People and their relatives told us that there were activities available and games if they wanted to get involved and they enjoyed the music entertainment. They told us they had the opportunity to go on occasional outings.

Relatives, we spoke with, told us that they were kept informed and involved. They told us that they felt able to ask any questions and request information.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people told us, what we observed and the records we looked at.

Although we spoke with some people who lived in the home during our inspection, they were not always able to tell us about their experience. This was because most of the people in the home had dementia. Therefore we spoke with six people's relatives who were visiting the home and observed people receiving support from staff to make our judgements.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Relatives of people who used the service were confident that their family members were in safe hands. They told us that they were kept informed of incidents that occurred and felt assured that staff would take appropriate action to look after people and keep them safe.

We saw that there were moving and handling plans in place to help ensure people were supported with moving in a safe way. Staff were aware of these plans. We saw that mobility equipment was checked on a regular basis to ensure it was in good condition and safe to use. These checks meant that that people were not placed at unnecessary risk by the equipment used to help them mobilise.

Care plans were also in place to minimise the risk of people developing pressure sores. We saw that staff ensured that the care plans were followed in order to protect people from skin breakdown.

Staff were not always aware of people’s needs in relation to drinking safely. Some people needed their drinks thickened so they could swallow them safely. This was stated in their care plans. However, it was not clear from talking with staff that their care plans were always followed. This potentially put people at risk of not having their drinks in a safe way. A compliance action has been set for this and the provider must tell us how they plan to improve.

Improvements were also needed in relation to some aspects of record-keeping to ensure that there were accurate records about people’s care and how to meet their needs. We found that some records were stored away from where care was delivered which meant there was a risk of delays in staff being able to locate people’s records when required. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

Relatives spoke highly about the care provided at Foxes Moon. For example, one relative told us, "I don't think they could do any more. I'm quite happy." Another person commented, "I really can't fault the care...they look after her very well." People told us that staff understood their family member’s needs. One relative described how their family member had been much more settled since coming to live at the home because staff had taken the time to get to know them.

We found that staff were able to tell us about people’s interests, likes and dislikes. They were able to understand what was important to them and respected their wishes.

There was a range of activities available for people including quizzes, arts and crafts activities and music sessions which helped ensure they had things to do in the home. People were also supported to maintain relationships with their friends and family who were welcomed into the home at any time and involved in planning and delivering their care.

We looked at how the home met the specific needs of people with dementia. It was not always clear that people fully understood the meal choices they were being offered and received the support they needed. Meal time arrangements needed to be reviewed in order to take into account the specific needs of people with dementia. A compliance action has been set for this and the provider must tell us how they plan to improve.

Improvements were also needed in relation to providing a care environment that was always dementia-friendly. For example, during our inspection, we observed an activity going on in the lounge while other people watched television, spent time with their relatives or enjoyed a visit from a therapy dog. This created a busy and noisy environment which may be difficult and confusing for some people with dementia. The provider told us that they were planning to convert another room in the home into a quiet lounge which would provide people with more space.

Is the service caring?

We observed people receiving support from staff who spoke with them in a kind, patient and respectful way. Staff were observed to communicate with people as they supported them which helped them understand what was happening.

Relatives told us that people’s privacy and dignity were upheld and that their family members were treated well. For example, one relative told us, “They’re very good…they have a chat with people. They are always polite…always very nice to people”, while another person commented, “They’ve got the right attitude.”

Is the service responsive?

The home responded to people’s changing needs. Where staff had concerns about people's health, we saw that this had been reported to their GP and professional advice was sought to ensure they received the right care.

Relatives had confidence that the home was able to meet their family members’ needs. They gave us examples of how the home had responded to changes in their health, for example by caring for them in bed and calling the doctor out when they were unwell. They had confidence that staff knew what they were doing and had a flexible approach to people's care.

Is the service well-led?

There was a clear management structure in the home.

The provider carried out regular checks on the quality of the service by asking people for their views. They made improvements to the service based on the feedback they received.

Checks were also carried out to ensure that staff followed safe procedures and understood their roles and responsibilities in the home.

The provider had systems in place to monitor accidents and incidents which meant that they were able to identify emerging risks and take appropriate action.

Relatives of people who lived in the home told us that they felt able to approach staff or management with their comments or concerns. They felt sure that staff would listen to them and the provider would take action to resolve any issues.