About the service:

Saxilby Care Centre provides accommodation, care and support for up to ten people who experience physical disabilities and those live with dementia.

There were ten people living at the service at the time of the inspection.

People’s experience of using this service:

People continued to receive safe care. Staff had a good understanding about how to keep people safe from harm and the safeguarding procedures that should be followed to report any incidents of concern or abuse they identified. Risk assessments were in place to manage potential risks within people’s day to day lives, whilst also promoting their independence.

Staff recruitment procedures were in place and appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Sufficient staffing levels were being maintained and at the time of our inspection, staffing support matched the level of assessed needs for the people who lived at the service.

Staff induction and on-going training was provided to ensure staff had the skills, knowledge and support they needed to perform their roles. Staff told us they were well supported by the registered management team.

Wherever possible, people's consent was gained before any care was provided. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff continued to treat people with kindness, dignity and respect. Care plans reflected people’s likes, dislikes and the way in which they had chosen to be cared for.

People were involved in reviewing their care and in making any necessary changes to the way care was provided. People had access to activities of their choice and were supported to maintain any interests or hobbies they had.

A process was in place which ensured concerns and complaints could be raised. People and their relatives had access to this information so that if needed, they were clear about how to raise any concerns or more formal complaints they had.

The service continued to be well managed. The registered provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

Rating at last inspection:

Good (report published January 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained rated good overall.

Follow up:

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

When we visited Saxilby House there were 10 people living at the home. We spoke with four people and observed how others were cared for. This was because some people had problems with their memory and could not tell us their experiences of the care they received. Other people said they did not want to talk to us. We also spoke with the manager, three staff members and briefly with a relative.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

If you want to see the evidence supporting the summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe living at the home. Staff we spoke with and records showed us that staff were trained and understood how to keep people safe.

Staff used appropriate techniques to help people move about and there was equipment available such as hoists, wheelchairs and walking frames.

Accidents and incidents were appropriately recorded and body charts were in place to identify any injury to a person.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There were no applications needed or made by the home under this legalisation since our last inspection visit. The manager and staff demonstrated a good understanding of situations in which an application may need to be made. Records showed staff had received training about this subject.

Staff used good infection control practices when they gave direct care to people and the home was generally clean and tidy. The arrangements for infection control and hygiene in the kitchen area were appropriate. However, the arrangements for infection control and hygiene in other areas of the home were not robust. For example, most waste disposal bins did not have lids, there was no clear system to ensure clean and dirty laundry were separated and the manager was not aware of up to date national guidance about infection control.

Is the service effective?

People all had individual assessments and care plans which set out their care needs. Records showed people had been involved in assessments and developing care plans.

People we spoke with told us staff did everything they wanted and needed. From speaking with staff and what we saw it was clear that staff understood people’s needs and wishes and provided care and support in the way people wanted.

Records showed people had access to a range of healthcare professionals some of whom visited people at home. We also saw staff supported one person to attend a hospital clinic on their own in line with their wishes.

Is the service caring?

We saw staff regularly spent time with people chatting about their lives and how they were feeling. People told us things like, “They’re lovely staff, they do everything I need” and “They’re [staff] always smiling.”

Staff spoke with people in a respectful way and made sure they were able to make their own choices and decisions whenever they were able to. There were arrangements in place to make sure people’s capacity to make decisions was taken into account when planning care. There was an advocacy service available if people needed it.

People’s preferences had been recorded such as what they liked to eat, where they liked to take their meals and how often they liked a bath. We saw staff knew people’s preferences very well and provided care and support in the way each person wanted.

Is the service responsive?

We spoke with people about social activities. They said things like, “I don’t want to do a lot but we had a good memory game yesterday”, “We like a bit of telly in the morning, keeps your brain active.” Although there was no formal activity plan in place, we could see people were supported to do things they liked and records showed when people had chosen to join in with activities.

Since our last visit the manager had carried out a satisfaction survey with people who used the service and their relatives. We saw the provider had listened and responded to people’s views. For example, they had made changes to the meals for one person and bought a new chair for another person.

We found there were no shower facilities within the home. Although people who currently lived in the home were happy with the bathing arrangements, there was no planning or provision made should their needs or wishes change.

Is the service well-led?

There were systems in place to assure the quality of the care provided within the home. For example, we saw care files were audited and reviewed regularly. People’s personal records were accurate and complete.

We saw people who lived in the home were consulted about how they liked their care to be delivered and were asked for their views about how the home was run.

Staff told us they were well supported by the provider and the manager and their views were listened to.

Due to the complex needs of the people who used the service we used a number of different methods to help us understand their experiences when we undertook our visit. Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with two people who used the service and one relative and asked them for their views. We also spoke with two senior care workers, and the registered manager. A representative for the provider also attended at the end of the inspection. We looked at some of the records held in the service including the care files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care and received care and support that met their needs. A person who used the service told us, “I feel I do what I want to.” A district nurse told us one person who used the service was very poorly and said staff, “Really cared and responded to him well.”

We found people who used the service were kept safe and protected from harm. Staff knew how to respond to any allegation of abuse. We asked two people if they felt safe in the home and they both said they did.

The staffing levels were increased during the inspection to ensure there were sufficient and suitable staff employed. A relative told us, “There used to be a cook, but now the (care) staff have to do this.”

We found the provider did not regularly assess and monitor the quality of service that people received.

During our visit we spoke with three people who lived at the home, a relative of one person, a visiting professional, four staff members, the registered manager and the home owner.

We looked at records. These included care records and information about how the service operated. We also spent some time in communal areas of the home. We spoke with people and observed how staff interacted with, and supported them to do what they wanted to.

One person said, “This is my home. It is a place I feel safe and comfortable in and I get on well with all the staff."

People's needs were assessed, planned and reviewed. Where appropriate we found evidence that relatives of people who used the service were involved in reviews about peoples care and treatment. A visiting relative told us, "I visit at any time I want. I feel this home provides a homely and supportive environment for xxx."

We saw that people were well cared for, treated with dignity and respect and were able to make choices in every day living activities.

We found that the provider monitored the service and gained views on the service from relatives and from people who used the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We inspected Saxilby House over two days which were 26 November 2015 and 10 December 2015. The inspection was unannounced on both days.

Saxilby House is situated in the village of Saxilby which is approximately six miles from the city of Lincoln. It provides care and support for up to 10 older people, some of whom experience issues with memory loss associated with dementia. On the first day of our inspection five people were living in the home. On the second day three people had been admitted for a short respite stay and one person was visiting the home for day care support.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection no-one living in the home had their freedom restricted and the provider had acted in accordance with the Mental Capacity Act 2005 DoLS legislation.

The last inspection took place in May 2014 and we found the provider was in breach of Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010. This was because they did not have suitable arrangements in place to fully protect people from the risk of infection. During this inspection we found that the provider had taken the necessary steps to ensure people were protected from the risk of infection.

People were kept safe by staff who knew how to identify and report any concerns related to their health, safety and welfare. Their medicines were managed safely and they were supported to access appropriate healthcare. They were provided with a healthy diet and enough drinks to help them stay well.

People were encouraged to make there own decisions and choices wherever they were able to do so. Arrangments were in place to act in the best interests of those people who could not make decisions for themselves.

People’s privacy and dignity were maintained by staff who cared for them in a warm and pleasant manner. Staff understood their needs and wishes and they were consulted about their care. People were supported to engage in some activies and interests of their choice. However, for people who could not access meaningful pastimes without support, there were no clear arrangments in place.

Staff were recruited in a way that ensured they were suitable to work within the home. They received appropriate training and support to enable them to meet people’s individual needs and preferences.

The home was managed in an open and supportive manner. People and their relatives were able to express their views about the services provided and they knew how to raise concerns or complaints if they needed to. The registered manager regularly checked the quality of the service provided for people so that improvements could be made where needed.