This inspection took place on 10 January 2018 and was unannounced. This meant the provider and staff did not know we would be visiting.

At the last inspection in April 2016 the service was rated Good. At this inspection we found the service remained Good.

Loxley Chase Care 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. At the time of our inspection 30 people were using the service.

There was a registered manager in place. 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 registered manager was also one of the owners and registered providers of the service.

People and their relatives told us staff kept them safe. Risks to people were assessed and plans put in place to reduce the chances of them occurring. Plans were in place to provide a continuity of care in emergency situations that disrupted the service. The provider had infection control policies in place. Medicines were managed safely. People were safeguarded from abuse. The provider and registered manager monitored staffing levels to ensure there were enough staff to support people safely. The provider’s recruitment process reduced the risk of unsuitable staff being employed.

People and their relatives told us staff had the knowledge and skills needed to provide effective care. Staff were supported with regular training, supervisions and appraisals. 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. People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health. The premises were adapted to meet the needs of people living there.

People and their relatives described staff as kind and caring and spoke positively about the support they provided. We saw numerous examples of kind and caring support being delivered during our inspection. Staff treated people with dignity and respect and promoted people’s independence. Care plans contained personalised information to ensure people’s needs were met in a way which reflected their individuality and identity. Policies and procedures were in place to arrange advocacy services where needed.

People and their relatives said staff provided personalised care that responded to people’s preferences and needs. Care was planned and delivered on the basis of people’s assessed needs and preferences. Policies and procedures were in place to support people being discharged from the service. People were supported to access activities they enjoyed. Policies and procedures were in place to support people with end of life care. The provider had a complaints policy, and people and their relatives said they were aware of it and knew how to raise any issues they had.

Staff spoke positively about the culture and values of the service and said they were supported by the provider and registered manager. People and their relatives spoke positively about the management of the service. Feedback was sought from people and their relatives through an annual survey and at regular meetings. Regular staff meetings took place, and staff said they found these supportive. The registered manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service. The provider was working on a number of projects to enhance the wellbeing and quality of life of people living at the service. The registered manager had informed CQC of signif

This inspection took place on 23 March 2016 was unannounced. This meant that the provider did not know we would be visiting. The service was last inspected in 2015, and at that time was meeting the regulations we inspected.

Loxley Chase is a three-storey converted building providing single en-suite accommodation for up to 30 people. There is a lift giving access to all floors. The home has a large lounge as well as a smaller snug area, a dining room and a separate room for activities and social events. It is situated close to shops and amenities and it is on a bus route providing access to Middlesbrough town centre. At the time of our inspection 29 people were using the service, many of whom were living with dementia.

There was a registered manager in place. 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.

People were safely supported to access their medicines. Accurate records were kept of administration, and medicines were securely and safely stored. We made a recommendation that the service consult national guidance when recording the use of covert medicines.

Risks to people arising from their health and support needs or the premises were assessed, and plans were in place to minimise them. Risk assessments were regularly reviewed to ensure they met people’s current needs. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe.

The service monitored people’s levels of dependency and used this to asses staffing levels. A number of recruitment checks were carried out before staff were employed to ensure they were suitable.

Staff received training to ensure that they could appropriately support people, and the service used the Care Certificate as the framework for its training. The Gold Standard Framework training was used in End of Life training.

Staff received support through regular supervisions and appraisals. Staff felt confident to raise any issues or support needs they had during supervisions and appraisals.

Staff understood and applied the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards to ensure that people’s rights were protected. Care plans contained evidence of mental capacity assessments and best interest decisions.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People told us they had a choice of food at the service, and that they enjoyed it.

The service worked with external professionals to support and maintain people’s health. Staff knew how to make referrals to external professionals where additional support was needed. Care plans contained evidence of the involvement of GPs, district nurses and other professionals.

Staff treated people with dignity, respect and kindness. People and their relatives spoke highly of the care they received.

Procedures were in place to support people to access advocacy services should the need arise.

Care was planned and delivered in way that responded to people’s assessed needs. Plans contained detailed information on people’s personal preferences, and people and their relatives said care reflected those preferences. Care plans were regularly reviewed to ensure they met people’s current needs.

People had access to a wide range of activities, which they enjoyed. The activities co-ordinator ensured that everyone at the service could access at least some of the activities, including people living with dementia.

The service had a clear complaints policy that was applied when issues arose. People and

During the inspection we spent time observing the interactions with staff and people who used the service. We spoke with four people who lived at Loxley Chase Care Home and four relatives. We also spoke with the manager, deputy manager and a number of staff of different grades and roles.

All of the people we spoke with were very satisfied with the care they received. Comments included, "Staff are very good and very helpful.” “It is a very, very nice place.”

Relatives we spoke with were extremely positive about the care and support provided. They said, "The staff are very friendly and I am happy with how mum is cared for.” “The staff are very good and are very quick to react to anything.”

We saw that staff were attentive and treated people with dignity and respect. Staff responded quickly when people called for assistance and provided care in a kind and caring way.

We found that people had care plans in place that in the main were up to date and in the main reflected their care needs. Where they weren't, the manager had already taken action to address this.

We also found that staff worked in collaboration with other health and social care professionals.

We found that effective systems were in place for the maintenance and servicing of the premise.

We found that people's needs were met by sufficient staff.

We spoke with five people who used the service. They told us they were treated well, the staff were nice and they felt safe at the home. One person said “It’s like home from home.” Another person told us “I am well looked after”, and “They know me well; I am treated with dignity and respect.”

We spoke with one relative of a person who used the service. This relative said, “They are very good”, and “They are on the ball here.”

We found that people were treated with dignity and respect. We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing.

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We also found people were cared for and supported by, suitably qualified, skilled and experienced staff.

We found there was an effective complaints system in place at the home.

We carried out this unannounced inspection on the 7th and 9th January 2015. We last inspected this service in January 2014.

Loxley Chase is a three-storey converted building providing single en-suite accommodation for up to 30 older people including people who were living with dementia. There is a lift giving access to all floors. The home has a large lounge as well as a smaller snug area, a dining room and a separate room, which is used for activities and social events. It is situated close to shops and amenities and it is on a bus route providing access to Middlesbrough town centre.

The home had a registered manager in place and they have been in post as manager since 2005. 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.

People living at the service received good, kind care and support that was tailored to meet their individual needs. Staff ensured they were kept safe from abuse and avoidable harm. People we spoke with were positive about the care they received and said that they felt safe.

Staff were trained and understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority. Staff said they would be confident to whistle blow (raise concerns about the home, staff practices or provider) if the need ever arose.

Accidents and incidents were monitored each month to identify trends. We found that when trends were found action was taken. For example certain times of the day were highlighted as being high risk, so the provider ensured extra staff were rostered on to cover these times.

We found people were cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers and a we saw evidence that a Disclosure and Barring Service (DBS) check had been completed before they started work in the home. The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults, to help employers make safer recruiting decisions and also to prevent unsuitable people from working with children and vulnerable adults.

We observed a morning medicines round and observed medicines were administered and stored correctly.

We observed two meal times. On the first observation we saw staff supporting people to eat, one of whom tried to feed two people at once, which meant neither person received the support they needed. On the second observation two members of staff were feeding two people in the lounge. Both members of staff were sat chatting to each other and did not seem to be including the people they were feeding, and one of the staff members was feeding the person whilst sitting at the side of them, not directly in front of them. We discussed this with the registered manager and the owner who said they would act on this immediately with staff.

The service was clean and tidy. We observed the cleaning rota that highlighted what needed cleaning when. We saw there was plenty of personal protection equipment (PPE) such as gloves and aprons. Staff we spoke to confirmed they always had enough PPE. The infection control policy was in need of updating to include contaminated bedding and clothing being placed in red bags.

The registered manager had been trained and had a good knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood when an application should be made, and how to submit one. Staff did have a limited understanding but were booked in for MCA and DoLS training on the 25th February 2015.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. The care plans included risk assessments which were sufficiently detailed for each individual.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

Staff received training to enable them to perform their roles and the service looked at ways to increase knowledge to ensure people’s individual needs were met. Staff had regular supervisions and appraisals to monitor their performance and told us they felt supported by the registered manager.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were also supported to use equipment they may need to maintain their independence whilst staying at the service such as adapted plates and cutlery. People also had a choice of which dining room they ate in.

We saw people had access to advocacy services. Advocacy seeks to ensure that people, particularly those who are most vulnerable in society, are able to have their voice heard on issues that are important to them). One person used such a service from Avalon, this had been set up where they had previously lived and was kept going once the person moved to Loxley Chase.

People who used the service were encouraged to be as independent as they wanted to be. They often went for cream tea at Nunthorpe Hall. We saw evidence of some excellent activities taking place at the time of our inspection.

The service had a system in place for the management of complaints, although not all complaints were documented. One relative we spoke with related a concern, the registered manager rectified this at the time of our inspection and the relative was satisfied with the outcome.

There were effective systems in place to monitor and improve the quality of the service provided.

We saw safety checks and certificates that were all within the last twelve months for items that had been serviced such as fire equipment and water temperature checks.