We carried out a comprehensive inspection of this service on the 18 May 2016, and a number of breaches to the legal requirements were found. After the inspection the provider told us what action they would take. We undertook a further inspection on the 12 July 2017 and found that the legal requirements were now being met.

Loughton Hall provides care and accommodation for up to 33 older people some of which had dementia. On the day of our inspection there were 31 people using the service.

At our last inspection, audits to assure the quality of service people received was not always carried out. The previous inspection also found that staff and the registered manager had gaps in their knowledge and required additional training. The principles of the Mental Capacity Act 2005 (MCA) had not been properly followed because signed consent to care was not always obtained and applications to authorise deprivations of people’s liberty (DoLS) had not always been made by the registered manager. People’s medicines were not always managed safely and risk assessments did not always accurately assess the level of risk for some people. The registered manager did not have a robust system for raising safeguarding concerns with the local authority. At this inspection we found that improvements had been made.

At our last inspection, we found that staffing levels were too low. At this inspection, we found that staffing levels had been increased, but because of the number of people who needed two people to assist them at night had also increased, that staffing numbers needed to be increased further.

The registered manager was present during our inspection. 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.

A programme of induction, training, supervision and appraisals for staff were in place and they had the knowledge and skills to care for people effectively. Specialist training was now being provided to staff.

People are 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 support this practice.

People's health needs such as their weights and nutritional and hydration needs were now recorded. People could access health services and their involvement was recorded.

Medicines were provided safely and when required. Staff carried out regular audits to ensure processes were reviewed and monitored for effectiveness.

Staff were caring, considerate and treated people with dignity and respect. People had developed caring and meaningful relationships with the staff that supported them.

Feedback was obtained from people who used the service, their families, representatives and staff and this was used to improve the service. People knew how to make a complaint and we saw that complaints had been dealt with appropriately.

This inspection took place on the 18 of May 2016 and was unannounced. This meant the staff and provider did not know we would be visiting.

Loughton Hall provides care and accommodation for up to 33 older people some of which had dementia. On the day of our inspection there were 31 people using the service.

The registered manager was present during our inspection. 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.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us they did not always have their needs and requests responded to promptly.

The service did not always have enough staff on duty to meet the needs of people, because some people’s dementia meant that they showed behaviours that required greater levels of staff input to manage them and the service struggled to recruit and retain some care staff.

Staff received a thorough induction and had access to regular supervision meetings with the manager. Staff and the registered manager had gaps in their knowledge in some areas and some staff required some additional training.

The principles of the Mental Capacity Act 2005 (MCA) had not been properly followed in regard to obtaining signed consent to care. Applications to authorise deprivations of people’s liberty (DoLS) had been made by the registered manager.

Medicine was not always managed safely and on occasions people received the wrong dose. The registered manager conducted regular audits but these did not include loose medication. The medicine dosage error had not been picked up by staff until we brought this to their attention.

Risks to people’s safety and welfare had not always been appropriately addressed and there was not a robust system for raising safeguarding concerns with the local authority, because the registered manager did not fully understand all the types of incidents or events that should be reported.

Accidents and incidents were appropriately recorded and investigated.

Risk assessments were in place for people who used the service but these did not always accurately assess the level of risk for some people.

Staff were caring and considerate and treated people with dignity and respect. We saw that people had developed caring relationships with the staff that supported them.

A quality assurance process was in place, and people who used the service, family members and staff were consulted about the quality of the service they received. Auditing remained ineffective in highlighting shortfalls in the quality and safety of the service. We noted the provider had recently introduced a new quality assurance system but this had not been fully completed.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service did not provide group activities to regularly access the community.

People’s needs were met by external health professionals who visited the home. The food on offer to people was nutritious.

People who used the service, family members and visitors were made aware of how to make a complaint and there was a complaints policy and procedure in place.

We saw staff checking for permission before giving care to people and noted that, when people refused or waved staff away, they respected the person’s decision. One person told us, "There is nothing forceful that happens here."

The service took account of people’s rights under the Mental Capacity Act 2005 (MCA). We saw from records that, where people had been assessed as lacking mental capacity, a relative or representative was consulted before making any decisions about the care offered to the person.

Care Plans were detailed, personalised and supported by risk assessments and guidance. Information was recorded in a clear format. Staff were able to describe people’s needs and demonstrated a good knowledge of their individual preferences.

Although staff had a good awareness of their responsibility to safeguard people from abuse, the provider's policy was not sufficient or accurate. This did not protect people from the risk of abuse.

Staff had regular support and guidance. There was an induction process in place and good opportunities for training. This meant that people were supported by staff that had been given the appropriate information to support them safely.

People told us that they felt well cared for and that they could talk to staff and share their views.

The manager had taken steps to ensure that risks were assessed and monitored and that incidents were learned from. This ensured that people's needs were met safely.

Some people using the service at Loughton Hall were not able to tell us about their experiences so we used a number of different methods to help us understand.

We observed the interactions between people using the service and the staff working at the home and listened to everyday events and activities during the course of the day. People using the service initiated interactions, approached staff with confidence and were responded to in a warm and respectful way.

People who used the service told us they were happy living at the home and they were well looked after. One person told us, “I’m happy living here.” Another person told us “Everything is fine here. It’s nice and peaceful.” One person said, “It’s a very nice home.”

We saw medication being given to people who use the service. This was undertaken to a good standard and with regard to people’s dignity.

We spoke with two visitors to the home during our visit to the service on 11 October 2012 and after that visit, we spoke on the telephone with two other relatives who frequently visited the service. They all told us that they felt that people were provided with good care and had support for social and leisure activities. They said that people were well cared for by adequate numbers of competent staff, were supported to make decisions, were listened to and were safe living in Loughton Hall.

Where people were unable to provide a verbal response or tell us verbally their experiences, for example as a result of their limited verbal communication, we noted their non verbal cues. These indicated that people were generally relaxed and comfortable and found their experience at the home to be positive.

Comments from people who use the service about the care and support provided at Loughton Hall were complimentary. People with whom we spoke told us they were happy living at the home and that they were satisfied with the care and support provided by staff.

Comments recorded from feedback from relatives and visiting professionals in July 2011 told us that in general people were happy with the care and support provided. Comments included “I am really delighted with the care my relative receives at Loughton Hall, many thanks.” and “I am very pleased with every aspect of Loughton Hall, our relative is very settled and happy even though they do not remember everything about their day. All your staff are very caring and pleasant.”

People told us they found staff to be polite and respectful when staff spoke to them and that they are able to express their views.

Where people were unable to provide a verbal response or tell us verbally of their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Loughton Hall to be positive.

People told us they were happy and liked living at Loughton Hall. They also said that the meals provided were of a good quality. People stated that they receive their prescribed medication when they should.

Comments from people who use the service and relatives who completed the service’s quality assurance survey undertaken in October 2010 were positive. Comments included “Very impressed with Loughton Hall”, “All the staff are clearly spoken, cleanly dressed and polite”, “As a resident I am very happy and comfortable” and “I would be happy to recommend the home. My relative has settled well and is very happy and well looked after. We as visitors are always well received and all the staff I have met have been lovely”.

People also told us they find the home’s environment to be clean and tidy.

We were also told that staff at the home were very good and there are sufficient numbers of staff on duty.