This inspection took place on 27 September and was unannounced. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried out in April 2016. At that inspection we gave the service an overall rating of requires improvement. This was because we found the provider in breach of the regulations. We found staffing levels did not meet the needs of the people. Accidents and incidents involving people were not investigated and reviewed. People were not fully protected against risks associated with medicines. People did not always receive care that reflected their needs and preferences. Systems to assess, monitor and improve the quality and safety of the service were not effective. Records relating to people and to the management of the service were inaccurate, out of date and not consistently maintained.

Although not a breach of the regulations we also found where people lacked capacity to make decisions the reasons for making decisions on people's behalf were not clearly recorded by the provider. We found the environment did not fully meet the needs of people living with dementia.

Foxley Lodge Residential Care Home provides accommodation and personal care for up to 22 older people who are living with varying stages of dementia. There were 22 people using the service at the time of this inspection. The service had a registered manager who was also the provider. 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.

At this inspection we found the provider had taken the action they said they would and now met legal requirements. Arrangements to manage medicines at the service had been improved. Protocols for 'as required' (PRN) medicines had been updated. The provider reviewed each time this medicine was administered to check this had been appropriate for the person. Medicines supplied to the service had been changed by the dispensing pharmacy. This had reduced the risk of medicines not being appropriately administered. People received the medicines prescribed to them. Medicines were stored safely and securely.

There was now enough staff deployed at the service to meet people’s needs. The provider used a dependency tool to assess, review and amend staffing levels as dependency levels at the service changed. We observed staff were present and assisting people when required and answered call bells promptly.

The provider’s arrangements to assess the needs of people prior to admission had been improved and considered how a person’s needs would impact on others at the service to decide whether this would be an appropriate admission to the service.

Records relating to people were now current and well maintained. The provider had reviewed and updated people’s care records and people's support plans were personalised and set out how care and support should be provided based on their preferences and choices. The provider reviewed people’s records to check that the support provided reflected what had been planned and to identify any changes required to the care people received.

Records relating to the management of the service had also been improved. The provider had reviewed and updated the service’s policies and procedures. This meant staff now had access to up to date information and guidance to support their working practices.

Systems to identify any new and emerging risks to people had been revised. The provider reviewed information recorded about accidents and incidents to identify any learning or improvements that were needed to current working practices to improve the quality and safety of the service for people.

The environment had been updated to meet the needs of people living with dementia. The provider had made ch

This inspection took place on 19 and 26 April 2016, the first day was unannounced. At our last inspection in April 2014 the provider met the regulations we inspected.

Foxley Lodge is registered to provide accommodation and personal care for up to 22 older people who are living with varying stages of dementia. Accommodation is arranged over three floors with access via a passenger lift. 18 of the 22 bedrooms are en-suite. On the ground floor, communal areas include two separate lounges, a kitchen, dining room, bathroom and toilet facilities and an office. There is an enclosed rear garden with paved area for people to access. There were 20 people using the service at the time of our inspection.

The service had a registered manager who was also one of the owners. 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.

The service did not follow consistent safe practice for the recording and safe administration of people’s medicines. Medicines documentation was not always completed appropriately and there were not always clear instructions for how medicines should be administered. This meant that people may not receive their medicines safely.

The provider did not ensure appropriate skilled and experienced staff were deployed at the home to meet the various needs of people who used the service. There was not enough staff on duty to provide activities or respond to people's needs in a timely way.

Staff were familiar with people's needs, and received regular training to keep their knowledge and practice up to date. We were not assured however that staff had the skills and expertise to support the specialist needs of the people using the service.

The arrangements to monitor service provision did not always identify shortfalls and ensure that people were well cared for and safe. The provider’s systems were not used effectively to keep checks on standards, develop the service and make improvements.

People using this service did not always experience responsive care and support that was appropriate to their needs. Care plans did not always record all the information staff needed to care for and support people effectively. We also found that records relating to staff and the management of the service were not up to date or consistently maintained. Incidents and accidents involving people who used the service were not always reviewed or investigated to check that appropriate action had been taken. In addition, people’s care and monitoring records were not consistently maintained to accurately reflect the care and support provided to people.

Where people lacked capacity to make decisions, staff were aware of how to support these people in line with the law although the reasons for making decisions on people’s behalf were not clearly recorded. Appropriate applications had been made to the supervisory body to restrict people’s liberty where required.

We found that areas within Foxley Lodge could be decorated and equipped more suitably for people living with dementia. The provider agreed to look at ways to improve the environment to provide more engagement and stimulation.

People had positive relationships with the staff who they described as caring and helpful. Staff respected people’s privacy and treated individuals with kindness and patience. Staff made sure people’s dignity was upheld and their rights protected. Staff were knowledgeable about the risks of abuse and the procedures for reporting any concerns.

People were supported to maintain good health and had access to healthcare services when they needed them. The service had made timely referrals for health and social care support when they identified concerns in people’s wellbeing. People were e

Foxley Lodge Residential Care Home provides residential care for people living with different stages of dementia. During the time of this inspection it was providing care for twenty people.

The home is arranged over three floors. On the ground floor, there are two separate lounges, a kitchen, dining room, and the manager’s office. There is a large outdoor space for people to spend time in. Bedrooms are arranged over all three floors and eighteen out of the twenty two bedrooms are en-suite. There was a registered manager in post at the time of our inspection.

People told us they were happy at the home and that they felt safe. Staff hadcompleted safeguarding training and were aware of the procedures to follow if they had any safeguarding concerns.

The premises and equipment were managed appropriately. The home was well maintained and equipment was serviced regularly. There was a working lift and stair lift at the home. Service records for fire alarm, call bells, smoke detectors and other equipment were seen.

The provider was in the process of reviewing the care plans and risk assessments. Where they had been updated, we saw that the care records were individual to people using the service and were person centred.

People were supported to eat if required. They were given enough time to finish their meals and were not hurried.

We observed interaction between staff and people using the service during lunch and during some activities. Staff tried to involve people during activities which people enjoyed.

We looked at training and supervision records for staff. We saw that staff had attended mandatory and more specialist training based on the needs of the people using the service. Supervisions were carried out on a regular basis by senior staff.

We found that there were sufficient numbers of staff with the right skills and experience to meet people’s needs. Staff that we spoke with felt staffing levels at the home were sufficient. People who used the service told us there was always someone available to help.

We carried out an unannounced inspection at night as we had received information of concern about the care and welfare of people who used the service at night. Concerns had been raised that people may be left dressed to sleep in chairs and that staff were not clear about the care they provided during the night. We spoke with two members of staff at the service. We looked at night records and looked round the building; we found most people were asleep in their rooms. While we observed the staff for a short period we were unable to speak with people at the service as they were either asleep or were unable to express their views to us. We found no evidence of the concerns raised about people's care and welfare at this inspection.

At our last inspection in November 2012 we identified areas where the provider was not meeting the essential standards of quality and safety. The provider sent us an action plan to tell us how it would become compliant with the regulations. We carried out this inspection to review improvements.

We spoke with people who used the service. Comments included, “they look after us quite well and have a chat sometimes” and “there has been big changes and improvements.” Some people were not able to express their views and so we observed the care provided. We spoke with two relatives and a district nurse who visited that day and six members of staff. A relative said they “were very pleased with the care. The staff are very kind.”

We found that the provider/registered manager and staff had taken action to address the compliance actions made at the last inspection. There were improved arrangements to ensure that people were supported with decision making and that their views were considered in the planning of care. Written care plans and records had been reviewed and personalised and gave a clearer picture of the support required. Safeguarding policies had been updated, procedures had been followed and staff were aware of what to do if they had concerns. Effective quality assurance systems were now in place.

We also found there were adequate procedures in place for infection control. Staff were provided with suitable training to carry out their work effectively.

At the time of our visit there were 22 people using the service. We spoke with six people and three visitors. We also spoke with six members of staff, the registered manager and the registered provider’s wife.

The majority of people living at Foxley Lodge do not have the capacity to fully share their views regarding their care. In order to make judgements about people's care experiences, we observed care practices; interactions with staff and tracked six people's records of care. Case tracking means we looked in detail at the care people receive.

Staff respected people's routines and preferences and ensured their dignity when providing personal care. People we spoke to commented that they found the staff to be “kind” and “always cheerful”.

Comments from visitors included, “the staff are exemplary and treat people with respect. They know everyone’s name” and “the staff are very caring.”

We found that people's care records were not always appropriately maintained, reviewed and monitored. People had not been fully involved in making decisions about their care. We also found that safeguarding incidents were not always correctly identified and reported appropriately. This meant that the service had not followed safeguarding procedures and did not give assurance that people were as protected as they should be.

There were insufficient systems in place to identify and analyse incidents that resulted in or had the potential to result in harm to people using the service.