This unannounced inspection took place on 15 and 17 May 2018. Loxley Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Loxley Lodge Care Home is registered to accommodate up to 42 people in one building. During our inspection, 31 people were using the service, including some people who were living with dementia.

The service had a registered manager at the time of our visit. 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 not always supported by a sufficient amount of staff to meet their needs in a timely way. Improvements were also to ensure sufficient checks were carried out in relation to medicines.

Risks to people’s health and safety resulting from the environment and in relation to specific health conditions had been assessed and mitigated in most instances. Further improvements were made following our feedback. People felt safe and were supported by staff who understood their responsibility to protect people from abuse. Staff were recruited safely and action was taken in relation to accidents and incidents to help prevent a reoccurrence.

People’s needs were assessed before they moved to the home. Staff received appropriate training and support to perform their roles effectively. People were supported to eat and drink enough and to maintain their health and risks associated with people’s nutritional and health needs were responded to. The premises had been adapted to meet the needs of the people. 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 home supported this practice. Although some people did not have specific mental capacity assessments and best interest decisions, the registered manager was in the process of completing these.

People were supported by staff who were kind and caring. Action was taken to relieve people’s distress and ensure they were comfortable. Staff described how they worked to meet people’s specific needs and were aware of their preferences. People were supported to communicate and make choices and people had access to independent advocacy to help them express their views. People could be assured that their privacy and dignity were respected by staff.

People’s care plans were in the process of being updated by the registered manager therefore contained variable amounts of person centred information. Not all of the care plans we viewed contained an accurate description of the person’s current care needs. The registered manager took action to address this following our feedback. It was not always clear how people were involved and planning and reviewing their care. We have made a recommendation about involving people in the production and review of their care plans. People did not always have a specific end of life care plan even when they had expressed their wishes with regards this aspect of care. People were provided with opportunities to make a complaint about their care and these were responded to.

Systems were in place to monitor the quality of the service; however these were not fully effective in identifying areas of improvement. People told us they enjoyed living at Loxley Lodge Care Home and staff told us the culture of the home was open and transparent. People’s feedback was sought in relation to the running of the care home and action was taken to make improvements in relation to this feedback. Staff felt supported by the registered manager and the provider maintained overs