Foxgrove Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service does not provide nursing care. Foxgrove Residential Home accommodates up to 24 older people in one adapted building. There were 17 people living in the service when we inspected on 27 April 2018. This was an unannounced comprehensive inspection.

At our last inspection of 23 May 2016 the service was rated Good. At this inspection we found the evidence to continue the rating for Good in the key questions safe, effective and responsive. However, the key questions for caring and well-led had improved and they were now rated Outstanding.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Without exception, people were provided with an exceptionally caring service. People’s diversity was respected and all people were treated equally regardless of their specific needs and culture. The actions of the staff in the service demonstrated to people that they mattered and were valued.

The service was very well-led. The registered manager understood their roles and responsibilities in providing a high quality service to people. This value was shared by the staff team who were extremely proud of the service they provided. The service had a robust quality assurance system to monitor and assess the service provided to people. These systems assisted the registered manager and provide to identify and address shortfalls promptly and to drive improvement. There was an open culture in the service where people, their relatives and staff participated in its development. As a result the quality of the service continued to improve.

The service continued to provide a safe service to people. This included systems designed to protect people from abuse and avoidable harm. Staff were available when people needed assistance. The recruitment of staff was done safely. The service was clean and hygienic. People received their medicines safely.

The service continued to provide an effective service to people. People were cared for by staff who were trained and supported to meet their needs. 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. People received care and support to maintain a healthy diet and good health. People were supported to access health professionals where needed. The environment was suitable for the people living there.

The service continued to provide a responsive service to people. People received care and support which was assessed, planned and delivered to meet their individual needs and preferences. People were supported to participate in activities that interested them. A complaints procedure was in place. There were systems in place to support people at the end of their life.

Further information is in the detailed findings below.

Foxgrove Residential Home provides accommodation and personal care for up to 24 older people, some living with dementia.

There were 18 people living in the service when we inspected on 23 May 2016. This was an unannounced 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.

There were procedures and processes in place to ensure the safety of the people who used the service. Risk assessments provided guidance to staff on how risks to people were minimised. There were appropriate arrangements in place to ensure people’s medicines were stored and administered safely.

Staff were available when people needed assistance, care and support. The recruitment of staff was done to make sure that they were suitable to work in the service and people were safe. Staff were trained and supported to meet the needs of the people who used the service.

The service was up to date with the Mental Capacity Act (MCA) 20015 and Deprivation of Liberty Safeguards (DoLS). People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner. People, or their representatives, were involved in making decisions about their care and support.

People were provided with personalised care and support which was planned to meet their individual needs. People were provided with the opportunity to participate in activities which interested them. A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

There was an open and empowering culture in the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed promptly. As a result the quality of the service continued to improve.

Foxgrove Residential Home provides accommodation and personal care for up to 24 older people, some living with dementia.

There were 16 people living in the service when we inspected on 7 July 2015. This was an unannounced 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.

There were procedures and processes in place to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how the risks to people were minimised. There were improvements needed in the ways that risks to people were identified and acted on.

Staff were trained and supported to meet the needs of the people who used the service. Staff were available when people needed assistance. However, improvements were needed in the staffing in the service to ensure that people are safe and provided with the care that they needed in a timely manner.

People, or their representatives, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions. However, improvements were needed in the ways that staff were provided with guidance in care records about people’s specific care needs and how staff were provided with up to date information about people’s changing needs. The service was up to date with changes to the law regarding the Deprivation of Liberty Safeguards (DoLS).

There were procedures in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to. There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

Staff had good relationships with people who used the service. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People’s nutritional needs were being assessed and met. Where concerns were identified about a person’s food intake, or ability to swallow, appropriate referrals had been made for specialist advice and support. A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

There was an open culture in the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed. As a result the quality of the service continued to improve.

Our inspection of 8 May 2014 found that the service needed to make improvements in the way they gained and recorded people's consent to care. We had concerns about the training staff received and the information and subjects covered in a recent refresher course staff had taken. During this inspection we checked that improvements had been made.

We spoke with four people who used the service. We also spoke with one person's relative and three staff members. We looked at five people's care records. Other records viewed included staff training records, health and safety checks, staff and resident meeting minutes and satisfaction questionnaires completed by the people who used the service and staff. We considered our inspection findings to answer five questions we always ask; is the service safe, effective, caring, responsive and well led? This is a summary of what we found:

Is the service safe?

When we arrived at the service the staff on duty asked to see our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure the safety of people using the service.

People told us that they felt safe using the service. One person told us, “The staff are lovely. I feel safe here.”

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us that the service had begun a programme of staff assessment of safeguarding knowledge through the supervision process. This would ensure that all staff were regularly assessed in this area as well as receiving their mandatory training This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw records which showed that the service responded appropriately to concerns or allegations of abuse.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "I get everything I need." Another person said, "I can't fault it here." Another person said, "I am very happy here." We also spoke with a person's relative who told us that they felt that their relative was well looked after. They said, "I have no problems at all with them (the service)."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, "I get on well with all of them." Another person said, "They are all very kind and they work so hard."

People using the service, their relatives and other professionals involved with the service completed satisfaction questionnaires. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken into account and listened to.

People told us that they attended meetings to discuss the way in which the service operated.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service had a system for regular auditing and monitoring of the quality of the care provided to people who used the service and records seen by us showed that identified shortfalls had been addressed. People who used the service had access to regular forums where they could discuss their care and staff were required to attend staff meetings on a regular basis. As a result the quality of the service was continuingly improving.

During our inspection we spoke with five people who used the service and one visiting relative. We also spoke with the new manager, visiting quality manager for the provider and two staff. We inspected people's care records, staff training and supervision records and documents relating to the quality of the service and health and safety checks undertaken by the provider. Below is a summary of what we found.

During our inspection we looked to see whether we could answer five key questions: is the service safe, effective, caring, responsive and well led?

Is the service safe?

The provider had effective safeguarding procedures in place to protect people from the risk of abuse or harm.

We looked to see whether there were the right levels of staff working at the service. We found that there were enough staff to meet people’s needs.

The service had a safe medication administration system in place. People received their medications on time and staff were trained to support people safely.

The service had a robust recruitment process in place which meant that they checked and ensured that staff were fit and safe to work with vulnerable people.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to improve.

Is the service effective?

People's health and care needs were assessed before they came to the home to determine their needs and make sure the service could meet them effectively. Care plans seen included information about the care and support provided to people such as support with their personal care needs, mobility, behaviour and medication.

We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people's care and support needs remained appropriate and accurate. There was no evidence that people had been involved in the review of their care.

We had concerns about the training staff received. We had concerns related to the information and subjects covered in a recent refresher course staff had taken.

Is the service caring?

We saw staff were attentive to people's needs throughout our inspection. Staff interacted positively with people and gave people time to respond. We found staff showed patience when communicating with people who used the service.

People told us that the staff were caring. One person said about the service and staff, “Oh yes very happy.” Another said, “They are very good.” A visiting relative we spoke with told us about staff, "I have nothing but praise for them."

Is the service responsive?

We saw people were able to access help and support from other health and social care professionals when necessary.

Although some activities took place at the time of our inspection there were no evidence in any of the recent records we saw that showed how people were involved and engaged within the service or assisted to access the community.

The service responded well to concerns about the safety of people who used the service. A visiting relative told us that the service always responded to any issues and addressed these.

Most people told us that the service responded to their needs. One person told us, “The staff are very good, couldn’t wish for better.” Another person told us about making their appointments and that the service, “Have a driver, who takes you to appointments.”

Is the service well-led?

The service had a quality assurance system in place to identify areas of improvement. There were regular audits on medication and the environment.

Records seen by us showed that identified repairs and maintenance were addressed promptly. As a result the quality of the service was continuously improving.

One person spoke to us about the new manager, they told us that when the new manager started they came round and introduced themselves and said, "(Manager) is very good, has time to talk to you and listens."

The staff members we spoke with told us that since the new manager had started things had improved and they felt well supported and able to access the manager for support. However there had been no recent formal arrangements in place for supervision or appraisal which meant that we could not be assured that staff were receiving appropriate professional development and support.

Our inspection of 4 June 2013 found areas of non compliance. We completed a follow up inspection on 21 August 2013 to check that improvements had been made.

We found that the provider had made improvements to the way they supported their staff. The provider had taken appropriate steps to implement effective systems to train and supervise their staff. We were satisfied that the provider had taken all necessary actions to meet with the regulations for supporting workers.

During our inspection we spoke with three people who used the service and asked them to tell us how they felt they were being cared for. One person told us, "To me this is home.” We asked people how they felt the staff treated them. One person said, "Staff are very capable and efficient and very kind."

We observed that the staff were attentive to people’s needs. Staff interacted with the people who used the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance. The people we saw were relaxed and interacted with each other.

The service had good safeguarding procedures in place to ensure that people were safe. We found that the provider had good quality monitoring systems in place.

We found shortfalls in the provider's support of their staff in terms of supervision, annual appraisals and mandatory training.

We spoke with five people who used the service who told us that they were treated with respect, their needs were met and they were consulted about the care and support that they were provided with. We asked one person if the staff were respectful and they said "Very respectful, very." Another person said "I'm very happy here, I feel like I am living in a 4 star hotel." Another person said about the care and support that they were provided with "I could not be happier."

People told us that they were provided with enough to eat and drink. Two people said that they had gained weight since they had been living in Foxgrove Residential Home. One said that they had asked for smaller portions so they did not put on too much weight.

People said that they were provided with an activities programme which interested them. One person told us about the various outings that they enjoyed, such as having fish and chips at local coastal areas.

People told us that their health care needs were met. One person said that the doctor was called when they were unwell. Another person explained how they had been supported to improve their mobility and independence since they had used the service.