This inspection took place on 7 and 8 August 2018 and the first day was unannounced. This meant no-one at the service knew we were planning to visit.

We checked progress the registered provider had made following our inspection on 15 May 2017 when we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were Regulation 12, Safe care and treatment; Regulation 18, Staffing; and Regulation 17, Good Governance.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well-led to at least good. During this inspection we found the registered provider was no longer in breach of Regulations 12 and 17. However, we found a further breach of Regulation 18; a breach of Regulation 10, Dignity and respect; and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, Notification of other incidents.

Loxley Court 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. Loxley Court is located on the outskirts of Sheffield. Accommodation is provided over three floors, accessed by a lift. Loxley Court accommodates up to 71 people across four separate units, each of which have separate adapted facilities. One of the units specialises in providing care and support to men living with mental health difficulties and associated behaviours that can challenge. There were 55 people living at Loxley Court at the time of this inspection.

There was not a registered manager at the service. The improvement manager had been acting as manager for four weeks at the time of this 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.

Staff told us there were usually enough staff employed to keep people safe. However, they felt there were too many agency staff employed and this impacted on their ability to meet people’s needs in a timely and effective way.

Staff told us they knew what it meant to treat people with dignity and respect. However, we saw this did not always happen in practice.

CQC had not been notified when a Deprivation of Liberty Safeguard (DoLS) had been authorised for a person living at Loxley Court. These notifications were retrospectively submitted following this inspection.

The design and adaptation of the premises did not fully meet the needs of people living with dementia. We spoke with the deputy manager about this and recommended they consider good practice guidance regarding ‘dementia friendly’ care homes.

The registered provider had recruitment procedures in place to make sure staff had the required skills and were of suitable character and background. We found three instances where these had not been followed. The head of improvement took immediate action to rectify this.

Systems were in place to ensure people were supported by staff who had the knowledge and skills necessary to carry out their roles in meeting people’s needs. Staff were suitably trained. However, staff did not receive regular supervision in line with the registered provider’s own policy and procedure.

Staff were knowledgeable about how to protect people from harm and what they would do if they had any safeguarding concerns. They were confident any concerns would be taken seriously by management.

We saw the premises were clean and well maintained.

Medicines were stored securely and procedures were in place to ensure people received their medicines as prescribed.

Staff unde

Loxley Court Care Home is located on the outskirts of Sheffield. It caters for up to 76 older people whose needs may include mental health or dementia. Nursing care is provided. Accommodation is provided over three floors, accessed by a lift, which includes a challenging behaviour unit on the ground floor for up to ten people. There are three double bedrooms; the remainder of the rooms are single. Each bedroom has an en-suite toilet. There are lounges and a dining area on each floor of the home. On the day of our inspection, there were 65 people living at the home.

Loxley Court had been operating for many years. Indigo Care Services Ltd took over the home and were registered with CQC in September 2016. This is the first inspection since the new providers were registered.

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.

This inspection took place on 15 May 2017 and was unannounced. This meant the people who lived at Loxley Court and the staff who worked there did not know we were coming.

We found three 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.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to any incidents to. However, some of the plans of care did not contain sufficient information to protect people from possible harm. We also found some staff were not following the directions given in the plans of care, for example the safe management of diabetes.

We found that there was no system for analysing these incidents and identifying trends or patterns. The registered manager was working on improvements with staff from the local authority's contracts team and the local clinical commissioning group to look at root cause analysis.

Prior to the inspection CQC had a number of notifications that staff had not had access to sufficient personal protective equipment and bedding appropriate for the level and type of care provided. The registered manager told us the budget for these was frequently overspent due to the increase in numbers of people living at the service and the complexity of their needs. However, the registered manager assured us that she always ensured their was sufficient equipment was in place.

Staffing levels were sufficient to meet people's needs. Staff had been received some training and support to provide them with the skills and knowledge to undertake their role. This included a better understanding about how to ensure that they worked within the legal requirements of the Mental Capacity Act (2005). However there was some outstanding mandatory training requirements and further work was needed to ensure that staff understood how to support people who challenge.

The home had a happy, positive atmosphere with friendly interactions between people and staff. Staff knew people well and were able to support them in a caring way. People were supported by staff that showed compassion and empathy.

People said they liked the food and were able to choose what they ate.

Staff knew people well and people told us the staff were caring. People’s privacy and dignity were respected and promoted.

A programme of activities was in place so people were provided with a range of leisure opportunities.

People said they could speak with staff if they had any worries or concerns and they would be listened to.

There were some systems in place to monitor and improve the quality of the service provided. Regular check