Foxburrow Grange

Updated 27 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors, a medicines inspector, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Foxburrow Grange is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Foxburrow Grange is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 11 December 2023 and ended on 12 December 2023. We visited the location's service on both days of the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 7 people, and 6 relatives, and observed care to help us understand the experience of people who could not talk with us. We spoke with the management team comprising of the registered manager, wing manager, wing supervisor, clinical lead and the nominated individual. The nominated individual (NI) is responsible for supervising the management of the service on behalf of the provider. We also spoke with 2 senior staff, and 6 care staff and the head cook. We reviewed a range of records, including 13 people's care plans and associated risk assessments, and all people’s medicine administration records and a variety of records relating to the management of the service, including audits and records relating to storage of medicines.

Updated 27 February 2024

About the service

Foxborrow Grange is a residential care home providing personal and nursing care to up to 69 people across 4 separate wings, 2 wings specialise in providing care to people living with dementia. At the time of our inspection there were 58 people using the service.

People’s experience of using this service and what we found

A small minority of people using the service had a learning disability. The registered manager told us their primary care needs were nursing. However, we expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. Based on our review of the effective and responsive key questions, the service was able to demonstrate they were meeting some of the underpinning principles of the Right support, right care, right culture guidance. All staff had completed training for people with a learning disability and autistic people. The service had implemented tools, such as social stories, designed to help people with a learning disability to process a particular situation, event or activity. People had been referred to the speech and language team (SaLT) team to be assessed for equipment and, or methods to help them communicate.

Systems were in place and being used for managing safeguards, but on occasion they were not given sufficient priority, or reported to the local authority for advice, as per the provider’s own guidance.

Systems to identify and address potential risks to people using the service, had improved. Management and staff had worked well with the dementia specialist team to develop a risk-based approach to effectively support people whose behaviour can sometimes present a risk to themselves, or others. Routine checks were now being carried out on clinical equipment, bed rails and wall bumpers to ensure these were safe and in good working order. However, further improvements were needed to ensure electrical sockets were assessed against the risks of tampering with and the risk of electric shocks or burns.

People were supported to eat and drink enough to maintain a balanced diet. However, staff did not always have access to up to date and reliable information about peoples’ specific dietary needs and choking risks. Whilst no people had come to harm, where changes had been made to their diets, such as changes in the size, texture or consistency of foods and fluids, these had not always been updated in their care records in a timely way. Therefore, staff did not always have the correct information to support people to eat and drink safely. Immediately following the inspection, the registered manager told us they had reviewed people’s records to ensure they contained accurate information. They had also sought additional training through the SaLT team for all staff, including catering staff to improve their understanding of managing dysphagia.

Staffing levels were reviewed on a regular basis to ensure there were enough staff deployed across the service. However, we observed, and staff told us, they struggled to meet the changing needs of people in Hedgehog unit. The registered manager agreed to review staffing numbers on Hedgehog unit to ensure people received timely care and support.

The service had made significant improvements to the management of medicines. However, improvements were needed to make sure people prescribed time sensitive medicines were given these within the recommended time frame. We have made a recommendation about following national guidance for administration of medicines.

Staff were recruited safely. Staff had received support, induction and training they needed which gave them the skills and knowledge to meet people’s needs. The service worked well with other professionals to understand and meet people's needs. Staff supported people to live healthier lives, and access healthcare services. A ‘Smiling Matters’ approach had been implemented to promote people’s oral hygiene.

Peoples' privacy, dignity and independence was respected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s risk assessments and associated care plans needed further development to ensure they were current, reliable, and relevant. Summary and extended care plans contained repetitive information which had the potential to cause confusion and/or error in the delivery of people’s care. We have made a recommendation about care planning.

Staff were not always responsive to people’s needs. People told us, and records showed staff response to managing pain, was not always dealt with quickly enough. The registered manager had recognised improvements were needed in relation to end of life care. They were working with their local

hospice developing training and support for all staff to improve advanced care planning, communication, and having uncomfortable conversations about death and dying.

Our previous inspection found the leadership and governance systems to assess and monitor the quality and safety of the service were ineffective. At this inspection we found Improved auditing process, including a monthly governance report which were identifying where improvements were needed, and the action taken. However, further improvements were needed to ensure governance systems encompassed the wider quality and safety issues we identified during this inspection. This included staffing levels / deployment of staff / quality and accuracy of information about people’s care needs and how they are to be supported.

We have made recommendation about quality assurance arrangements.

Improved analysis of incidents and accidents had led to a decrease in falls. Investigations into incidents to establish the cause were completed and learnt from to improve safety across the service.

Information received before and during the inspection reflected ongoing concerns about a poor culture across all departments. This focused on unsupportive management, and a lack management presence on the floor. Work was in progress in conjunction with the provider’s human resources to reach out to staff to improve morale, communication, and effective team working.

The management team had developed a range of ways to engage with people, their family, friends, and staff in a meaningful way. These included feedback from questionnaires, a family forum and a twice monthly newsletter to keep people and their relatives informed of any changes in the service and upcoming events.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate. (Published April 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breaches of regulations in relation to safe care and treatment, failure to protect people from unnecessary control and restraint, including the excessive or inappropriate use of medicines, and governance arrangements.

This service has been in Special Measures since 26 April 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive, and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Foxburrow Grange on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.