About the service: Foxton Grange is a care home that was providing personal and nursing care to 27 people living with dementia aged 65 and over at the time of the inspection.

People’s experience of using this service:

¿There had been several different managers since our last inspection in 2016 which had impacted on the stability of the home and staff morale.

¿Action plans to address shortfalls identified through the systems in place to monitor the quality and performance of the service, had not always been completed in a timely way.

¿Care plans needed to be improved to enable staff to provide care in a more person-centred way.

¿Complaints had not always been addressed within the timescales laid down in the providers policy.

¿Staff were friendly, passionate about their work and caring; they treated people with respect, kindness, dignity and compassion.

¿People developed positive relationships with staff.

¿People were protected from the risk of harm and received their prescribed medicines safely.

¿Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs.

¿ Staff had access to the support, supervision and training that they required to work effectively in their roles.

¿People were supported to maintain good health and nutrition.

¿Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005). The provider was aware of how to make referrals if people lacked capacity to consent to aspects of their care and support and were being deprived of their liberty.

¿Information was provided to people in an accessible format to enable them to make decisions about their care and support.

¿The service met the characteristics for a rating of “good” in three of the five key questions we inspected and rating of “requires improvement” in two. Therefore, our overall rating for the service after this inspection was “requires improvement”.

More information is in the full report

Rating at last inspection: Good (report published 16 September 2016)

Why we inspected: This was a scheduled inspection based on previous rating.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This was an unannounced inspection that took place on 27 July 2016.

Foxton Grange is registered to provide personal care and nursing home. It is situated in Leicester and accommodates up 36 older people, some of whom are living with dementia. At the time of our inspection there were 33 people using the service.

At the time of our inspection the service did not have a registered manager. This 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. A manager was in post and told us they intended to apply to CQC to become the next registered manager.

During our inspection the people using the service were relaxed, comfortable and safe. Staff supervised people discreetly and were quick to provide support and reassurance when it was needed. Staff understood the importance of protecting the well-being of people who might not be able to say if something was wrong.

The design and layout of the premises contributed to people’s safety. All areas were bright, clean and uncluttered. Communal areas led onto secure, enclosed gardens. We saw people enjoying these safely both on their own and with staff.

There were enough staff on duty to keep people safe and meet their needs. Staff had time to interact and socialise with people as well as providing personal and nursing care. At no time was anybody left waiting for assistance or treated in any way that would compromise their safety.

Prior to our inspection there had been some issues with medication management at the service. These were in the process of being resolved. Staff were working to an action plan and audits showed continual improvement in medicines safety over the last three months.

The staff were well-trained and understood people’s needs and individual preferences. They gave us examples of how they provided flexible care to fit in with people’s individual routines. For example if a person did not want to eat at a particular time staff served their meal at the time they chose. This approach gave people the freedom to decide what they wanted to do and when.

Staff treated people with care and kindness. They used different ways of enhancing that communication, for example by touch, ensuring they were at eye level with a person who was seated, and by altering the tone of their voice appropriately. They told us they liked working at the service because they had the opportunity to get to know and spend time with the people they supported.

People’s records and the care provided were personalised. Each person had a document called ‘My Life Story’ which included information on their background, family, work, and important life events. It also listed their favourite things including food, drinks, music, books, films, and clothes. It set out their care preferences and helped staff to provide care in the way people wanted it.

People told us they enjoyed the activities provided at the service. These were available every day, including weekends, on a group and one-to-one basis. One of the activities coordinators told us baking and exercise classes were especially popular with people. Music therapy sessions were provided twice a week and a visiting entertainer came once a month to hold a group concert.

There was a positive and calm atmosphere at the service. Staff were kind and helpful. They constantly interacted with the people using the service and included them in conversations and activities. The manager told us relatives were central to quality assurance as the people using the service were not always able to give their views due to their mental health needs. The manager had recently met with relatives to get their views on the service and whether any changes were needed

There were arrangements in place to regularly assess a

Most of the people who used the service were unable to give their views due to illness or disability. However we talked to relatives, and observed people being cared for by the staff at Foxton Grange.

Relatives told us the care at Foxton Grange was good and staff catered for the individual needs of the people who used the service. One relative said, “My relative has her hair done, her nails done, and a bubble bath twice a week.” Another commented, “The chef is really good and knows just what my relative likes. Soft food is presented beautifully – the vegetables are all done separately and the mashed potatoes are piped.”

Relatives said they thought the home had good staffing levels and a good staff team. One relative told us, “The staff here have always put the residents first and the care has always been excellent.” Another said, “The staffing seems better organised and I’ve never seen any residents left alone. Staff morale has improved and it’s nice to see the staff laughing and joking.”

Relatives also told us staff worked well with people who suffered from dementia. One relative told us, “The manager and deputy are both first class nurses and understand dementia care very well.” Another commented, “The carers are very good with confused residents. They are patient and gentle. They are always sitting with my relative and talking to her.”

Most of the people who use the service were unable to give their views due to illness or disability. However we talked to relatives, and observed people being cared for by the staff at Foxton Grange.

Relatives told us they thought the standard of care at Foxton Grange had improved. One said, "The home seems calmer now and more organised. (My relative) is more relaxed now than I’ve seen her in months.” Another told us, “(My relative’s) GP has commented on how well she’s doing here. After all she’s been though it’s wonderful to see her so happy. I think the standard of care here is excellent.”

We asked people what they would do if they had a concern about the service. One relative told us, ““If I had any concerns whatsoever I’d go to (the acting manager) or my relative’s named nurse, both are excellent.” Another said, “I’ve seen nothing to concern me here whatsoever.”

One relative told us they had previously raised concerns about the care of their relative in the home, and hadn’t always been satisfied with the response. However they felt there was more “openness” in the home now, and said they had confidence that the acting manager would take concerns seriously and address them.

We asked people to comment on the staff team. One relative told us, “I think the staff look after my relative beautifully. They help her to eat at mealtimes and they’re very patient.” Another said, “There’s been a lot of comings and goings but they’ve got some fine new nurses. I am now very happy with the staff here.” Although we acknowledge that relatives were satisfied with the staff team we had concerns that the recruitment procedure had not been followed for at least one new staff member.

Relatives also told us the management of the home had improved since our last inspection. One said, “Someone’s been round this place with a new broom – it’s so much better now.” Another commented, “I gather this home has been though a bad patch, well if that’s true it’s certainly getting back on its feet now. (The acting manager) is very calm – they don’t come any better than her.”

For this inspection we carried out three visits to Foxton Grange. One of these visits was undertaken by a CQC pharmacist inspector who looked at the storage of medicines and a selection of people’s medication records and care plans (Outcome 9 – Management of Medicines). Area of non-compliance was identified during this visit.

We carried out an inspection at Foxton Grange following concerns raised by the local authority about care and the management of risk in the home.

Most of the people who use the service were unable to give their views due to illness or disability. However we talked to one person who told us they liked living at Foxton Grange and thought the care was good. They said, “The staff are really excellent. They are attentive.” A relative told us, “The staff are very kind and very patient.”

However, we found evidence that some of the people who use the service may have been put at risk due to the home’s policies and procedures not being followed.

Most of the people who use the service were unable to give their views verbally due to illness or disability. However those we met appeared relaxed and comfortable. Staff encouraged them to make choices about what they ate, where they spent their time, and whether or not they wanted to take part in activities. Staff communicated with people effectively using speech, body language, and visual cues.

We saw lunch being served in one of the home’s two dining rooms. People sat in groups of two or three with care staff. The dining tables were well-presented with fresh flowers, tablecloths, and linen napkins. The meals looked nutritious and appetising. People had alternatives brought to them by the nurse on duty, who was serving, so they could choose which they preferred. Those who needed help with their meals were given it and no-one was rushed to finish. Staff chatted to people while they ate and the atmosphere was convivial.

In one of the lounges we observed staff socialising with people. The room was well laid out with four groups of easy chairs so people had a choice where they sat. Music was playing and there were books, pictures, and games available if people wanted them. A staff member was talking to one of the people who uses the service about their childhood. Another staff member was reminding another person that their relatives were coming that day. Staff were attentive, warm and knowledgeable about the people they were caring for.

The people who use the service appeared to get on well with the staff and enjoy their company. Staff worked with people on a one-to-one or group basis in a skilled and calm manner. They were warm and caring in their approach and the people who use the service responded positively.

We saw many incidences of staff interacting with people and helping them to take part in the daily life of the home. In all cases the people who use the service seemed to trust the staff and were willing to be assisted by them. Although staff were busy, they all found the time to have a quiet chat or a laugh and a joke with the people they cared for.

We did not speak to people who use the service during this visit. We observed people receiving care and support. We saw that care workers met the personal care and medical needs of people who use the service. People were supported to eat and drink so that they had sufficient nutrition and were hydrated. People were offered a choice of food and drink. Care workers knew about people's plans of care, but people were not always given the opportunity to be involved in planning their care. Care workers did not always respond to people who could not express their needs verbally, thereby failing to promote their dignity.

People who use the service are supported by care plans which record the support and care they need to help them live within a safe environment. Records show that the service contacts relevant agencies and organisations where they have concerns that the person maybe at risk due to them being unable to make informed and safe decisions about aspects of their daily lives.

Discussions with staff at the service show that the level of understanding of staff about the protection of people from abuse and their rights and welfare is not consistently understood or implemented.

People are being supported by people who in some instances have not received receiving training on the safeguarding of vulnerable adults or the mental capacity act or their training is not up to date, which has the potential to put people at risk.

We observed that staff were not always attentive to people’s needs, and did not always maintain people’s privacy and dignity when they made decisions on their behalf. This was demonstrated when staff assisted people to move without explaining to them what they were going to do. However, we also observed examples of good practice, where staff supported people to move after explaining what was going to happen to them, and recognising a person wanted a hot drink when they approached the drinks trolley.

We observed that people were not always assisted to move from their chair using appropriate techniques. We saw staff assist people using underarm lifting rather than moving belts when moving people from a sitting to standing position.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Foxton Grange is situated to the north-east of Leicester city. It accommodates up 36 people living with dementia. When we visited there were 32 people living at the home.

There was a registered manager in post at the time of this unannounced inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were safe at the home and staff knew what to do if they had any concerns about their welfare. Records showed staff had thought about people’s safety and how to reduce risk. They also knew how to protect people under the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLS).

People told us they felt safe at the home and comfortable with the staff. Relatives said their family members were well-cared for and respected as individuals. Staff worked well with people whose behaviour was, at times, challenging and knew how to comfort and reassure them.

There were enough staff on duty to meet people’s needs. Staff had the skills and knowledge they needed to provide effective care. They also had time within their working day to socialise with people and support them with their hobbies and interests.

The food was home-cooked and prepared in the way people wanted it. Staff knew people’s likes and dislikes and menus reflected these. People were supported to have a balanced diet and to have plenty to drink. Dieticians were involved If people needed extra help with nutrition and hydration.

People’s preferences were central to how their care was provided. They had access to health care professionals when they needed it. Staff took prompt action if there were any concerns about a person’s health.

The staff were caring and we saw many examples of staff communicating with people in a kind and sensitive way. Activities were a big part of life in the home and included music and drama therapy, visiting entertainers, trips out, and cookery. One-to-one activities were provided for people who preferred these, including swimming and hand massages.

People were involved in making decisions about their care, treatment and support. Staff knew their personal histories, likes, dislikes, and preferences. This meant staff got to know the people they supported and provide appropriate care. The home welcomed and catered for people from a range of cultural backgrounds.

The manager was friendly and approachable and knew the people who used the service and their relatives well. She listened and acted when people made suggestions about improving the service. The quality of the service was monitored and the people who used the service, relatives, and staff were central to that process.