Archived: Foxhill Manor Nursing Home

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; is the service caring? is the service responsive? is the service safe? is the service effective? is the service well lead?

This is a summary of what we found-

Is the service safe?

We found that some of the people who lived at Foxhill Manor Nursing Home engaged in high risk activities which had the potential to impact on themselves and others. Whilst these activities promoted people's independence there were no documented risk assessments to show how the risks were to be reduced or managed.

We also identified serious concerns relating to the safety of the environment. For example two of the bedrooms on the second floor had broken windows and one of the bathroom doors was hanging off its hinges. There was a lack of hot water in some of the bedrooms and bathrooms. We found that temperatures the temperature dispensed in the second floor shower and the ground floor bathroom ranged between 54 and 56 degrees Celsius which put people at risk of scalding. In addition the provider told us that the cooker was unsafe but they had continued to use it. We referred our concerns about unsafe water temperatures to the Health and Safety Executive.

Infection control systems were not in place, we looked at 12 of the 17 bedrooms and found the standard of cleanliness was poor; as were the communal bathrooms and two of the corridors. We found that two of the three communal wheel chairs had not been maintained in a clean and hygienic state nor were they maintained in good working order. We also found that some of the important fire safety checks had not been completed; we referred our concerns to the Fire Safety Officer.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to Care and welfare, Cleanliness and infection control, Safety and suitability of the premises and Safety, availability and suitability of equipment.

Is the service effective?

All of the people living at Foxhill Manor had an individual plan of care; these had been regularly reviewed to ensure that they contained appropriate information.

We saw people were comfortable and relaxed within their environment; in general people looked well cared for and were dressed according to their age; gender, culture and the weather conditions. We saw that people had access to a range of aids and adaptations to support their independence and mobility.

People had access to a range of activities which some people were able to engage with however people with access to board games and building blocks did not engage with them until staff supported them to do so; suggesting that these pastimes did not relate to their previous life experiences.

We saw that staff were responsive to people's individual needs; were protective of their privacy and dignity and used effective movement handling techniques.

We saw that people who were at an increased risk of the effects of pressure had access to pressure relieving equipment. We also saw that people assessed as being at nutritional risk were weighed regularly and had access to nutritional supplements and the NHS Dietetic Service. We also saw that people had access to general practitioners, district nursing services, community psychiatric nurses, podiatrists, dentists, opticians and other NHS services.

Is the service caring?

One person said 'The care is quite good here'. We saw that staff were swift to respond to people's needs and also to answer call bells. Staff treated people with respect and consideration and they were also mindful of their privacy and dignity.

We also observed that staff supported people to eat their meals with patience and consideration. We also observed that people who used the service were referred to by their preferred name.

Is the service responsive to people's needs?

People's needs were assessed and their individual care plans contained appropriate information about their needs and preferences. Individual plans of care also demonstrated that people were involved in decisions about their care and daily records demonstrated how the care and support was provided.

Defective medical equipment had been replaced and repairs to the stair lift to the second floor were ongoing. However two of the three communal wheelchairs were in need of significant repair to ensure people's health and safety.

People were able to select food from the menu which comprised balanced diet of freshly prepared food. However although fluid records showed that in general people had access to regular fluids; records were not always fully completed and totalled. Without this being done the provider and staff could not assure themselves that people were always in receipt of adequate amounts of fluid.

We have asked the provider to tell us how they will make improvements and meet the

requirements of the law in relation to Care and welfare and assessing and monitoring the quality of the service.

Is the service well lead?

Staff recruitment was managed effectively so that people were protected from the risks associated with the appointment of new staff. The provider had established a mechanism for obtaining the views of people who used the service and their representatives; we found that action was taken to address the concerns raised.

The provider had conducted quality assurance audits to ensure the safety of people who used the service. We found that where problems had been identified the provider had taken remedial action for example the replacement of medical equipment and repair of the stair lift. However two of the three communal wheelchairs were in need of significant repair to ensure people's health and safety. The provider also told us that the cooker was not fit for purpose but had continued to use it without taking the required action.

In addition, the provider's quality assurance checks had not identified serious concerns in relation to the maintenance of the premises and infection control systems. Risk assessments were in place to reduce and manage the impact of identified risk factors, such as the risk of falls. However there were no risk assessments in place relating to the engagement of high risk behaviours of some the people who used the service.

Fire safety records identified that checks on the emergency lighting had not been conducted and this was confirmed by the provider; we referred our concerns to the fire safety officer. Records showed people at risk of dehydration had fluid charts in place but were not always accurately completed; nor was their 24 hour intake calculated. Without this being done and reviewed on a daily basis the management could not be assured that people were in receipt of an adequate amount of fluids.

We have asked the provider to tell us how they will make improvements and meet the

requirements of the law in relation to assessing and monitoring the quality of the service.

We found people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found that people's personal records including medical records, staff records and other records relevant to the management of the services were accurate and fit for purpose. We also found records were kept securely and could be located promptly when needed.

Three people told us they liked living at Foxhill Manor Nursing Home and that the food was good. One person told us that the food was lovely and joked that they sometimes ate too much. All of the people that we spoke with confirmed that the staff were kind.

One of the people that we spoke with told us that the staff always asked for consent before delivering personal care. However other evidence did not demonstrate that formal consent was sought from people about other aspects of their lives.

One of the people we spoke with told us that they felt they were well looked after; they told us that the staff knew how they needed to be supported. Another person told us that they were comfortable living at Foxhill Manor, they told us that the staff were nice to them and they felt safe. However another person told us that they did not feel safe living there and they felt isolated because of the location of the home.

During our inspection we became concerned about the number of abusive incidents and other safeguarding concerns at Foxhill Manor Nursing Home and therefore referred our concerns to Northamptonshire County Council (NCC) Safeguarding Team, the NCC Commissioners and also the police.