All inspections: Broadlands Nursing Home

The inspection took place on 16 March 2015 and was unannounced. The last inspection was on 24 and 28 October 2014 to check whether action had been taken in respect of six warning notices we served on the provider for breaches of regulations. We found the provider had made some progress with meeting the regulations but was still breaching regulations in relation to care and welfare, assessing and monitoring the service, cleanliness and infection control and meeting nutritional needs. At this inspection we also checked on other breaches of regulations we identified at our inspection on 30 July and 7 August 2014 where we had asked the provider to make improvements. These breaches were in relation to safeguarding people from abuse, respecting and involving people, complaints and supporting workers.

Broadlands Nursing Home is a care home for up to 25 people with nursing needs, many of whom are living with dementia. At the time of our inspection there were 18 people living at the home.

The service did not have a registered manager in post. There was a newly appointed manager who had made the necessary application to become the registered manager. 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 knew, but did not always take, the necessary action to keep people safe in cases of possible abuse, such as when people sustained unexplained bruising. You can see what action we told the provider to take at the back of the full version of the report.

People’s care plans and risk assessments did not always contain sufficient accurate information. This meant staff were not always able to follow these documents as guidance on how to provide care appropriately. We were unable to evidence people received the right care and treatment when they developed wounds such as pressure ulcers. This was due to poor recording in wound management care plans and risk assessments, and of treatment records.

The manager had not ensured all people were able to reach a functioning call bell to call staff when they required assistance. However, the premises and equipment were clean and safe with regular health and safety checks carried out. Specialist equipment such as slings, hoists and pressure relieving mattresses were in place to help ensure people receive safe care.

Medicines management was safe. Decisions to administer medicines to people covertly were made in their best interests and the medicines policy contained sufficient detail on this to guide staff.

There were sufficient staff on duty to meet people’s needs. Recruitment practices were safe as checks were carried out before staff were employed to find out if they were suitable to work in the home.

People received the right support to eat and drink sufficient amounts and food was served at an appropriate temperature. Staff monitored people’s nutritional status appropriately and took the necessary action when there were concerns about people’s weight, such as referring them to appropriate professionals.

Staff received suitable training to carry out their roles and the manager had recently implemented a programme of staff supervision to provide individual support to staff.

Staff understood how to gain people’s consent before they provided care. The manager understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS). They had made several applications so that where people needed to be deprived of their liberty, this was carried out safely and in the correct way. These safeguards are there to help make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

People’s views and preferences in relation to their care, or the views of their relatives where appropriate, were not always recorded. This meant staff who were not familiar with the needs of the person they needed to care for or who were new to the service were not always able to refer to this information to provide care to people in the ways they wanted. However, regular staff had a good understanding of people’s preferences and wishes through discussion with them. People were treated with kindness, dignity and respect by staff.

People were provided with a range of activities to keep them stimulated both inside and outside the home. People and relatives were involved in discussions to plan activities.

People were encouraged to say what they thought about the service. There was a complaints policy that was available to all. The manager ensured complaints and suggestions were clearly recorded and acted upon to resolve issues raised.

The manager was aware of their roles and responsibilities and monitored the quality of the service provision through a range of audits. However, these audits had not identified the issues we found in relation to care planning, risk assessing, safeguarding, wound management, involving people in planning their care and recording their views.

The manager and director regularly gathered the views of people using the service and their relatives through regular meetings and questionnaires. The manager involved staff in the running of the home through a number of initiatives including regular staff meetings.

At this inspection we found breaches in relation to safe care and treatment, person-centred care and safeguarding. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 30 July and 7 August 2014. Ten breaches of legal requirements were found and we issued six warning notices. As a result we undertook a focused inspection on 24 and 28 October 2014 to follow up on whether action had been taken to address the breaches of regulations in relation to the warning notices.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 30 July and 7 August 2014

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This inspection was unannounced.

Broadlands Nursing Home is a care home for up to 25 people with nursing needs, many of whom were living with dementia. There were 20 people living at the home at the time of our inspection. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Before the inspection we reviewed the information we held about the service. At our last inspection in September 2013 we did not identify any concerns with the care provided to people who lived at the service. We spoke with the local safeguarding team and the local authority commissioning team to get more information about the service provided at the home.

There were breaches of regulations in relation to care and welfare, assessing and monitoring the quality of the service, cleanliness and infection control, medicines management, meeting nutritional needs and consent to care and treatment, safeguarding people who used the service, respecting and involving people, complaints and supporting workers. You can see what action we told the provider to take at the back of the full version of the report.

We found gaps in the planning to meet people’s individual needs and to ensure people’s welfare and safety. Planning and delivery of care concerning people’s moving and handling needs, wounds management, choking risk and nutritional monitoring was not always carried out safely.

Parts of the home and equipment were dirty and food hygiene procedures were potentially putting people at risk of food borne infections.

We found unsafe use and management of medicines. And people were not protected from the risks of inadequate nutrition and hydration. They were not provided with a choice of suitable food to meet their needs. People were not always given the necessary support, such as ensuring they had dentures that fitted their gums.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). No applications had been made to deprive people of their liberty and the provider had not considered whether any applications were required. Arrangements to act in accordance with people’s consent were not always in place. Where people were thought not to have capacity to make certain decisions, mental capacity assessments were not carried out and there was little evidence that decisions were made in people’s best interests in accordance with the Mental Capacity Act 2005 (MCA).

The manager and many staff we spoke with did not have a good understanding of the signs of abuse and how to respond appropriately to any allegations of abuse. Our findings were sufficiently serious for us to raise a safeguarding alert with the local authority.

People were not always involved in decisions about their care. For example, people were got out of bed early on different days according to a rota system to help the day staff. Staff did not always treat people with dignity and respect, such as by using people’s rooms regularly to access the garden.

The complaints system had not been brought to the attention of people and their relatives in a suitable format.

Staff did not receive appropriate training, supervision and appraisal. We found that, in general, staff understanding of how to meet the needs of people with dementia was poor and we did not see evidence staff had been provided with training in this area. Staff had also not been provided training in MCA and DoLS.

The provider did not regularly assess and monitor the quality of services or identify, assess and manage risks relating to people’s health, welfare and safety. We found serious risks of scalding and risks of falls from height through unsecured fire doors which the home had not identified. We reported to the Health and Safety Executive (HSE). We also identified concerns regarding fire safety which we reported to London Fire and Emergency Planning Authority (LFEPA). The service did not regularly seek the views of people using the service, relatives and staff.

The home had suitable arrangements in place regarding involving people in planning their end of life care. Also, people told us, and we saw, that staff treated people with kindness throughout our inspection.

Staff recruitment processes were safe and there were enough staff employed to meet the needs of people in the home.

Focused Inspection of 24 and 28 October 2014

There were 18 people living at the home at the time of our inspection.

We found that the provider had met most of the requirements of the warning notices. However, there were still breaches in relation to care and welfare, assessing and monitoring the quality of the service, cleanliness and infection control and meeting people’s nutritional needs. You can see what action we told the provider to take at the back of the full version of the report.

A new manager had started at the service just over a week before our inspection. We found they had many plans for improving the service, but had not had time to implement them yet. The provider had carried out some of the necessary improvements before the new manager commenced employment.

We found there were still gaps in planning to meet people’s individual needs and to ensure people’s welfare and safety. Planning and delivery of care concerning people’s moving and handling needs, choking risk and nutritional monitoring was not always carried out safely. However, staff had received training in moving and handling, and had a better understanding of how to do this safely. The manager had obtained new care plan templates and had completed one person’s care plan using the new, more comprehensive documentation. They planned to complete all the necessary care planning within a few weeks. People had been referred to speech and language therapists to assess choking risk and to provide guidelines, although this was an on-going project. The new manager understood the importance of regular nutritional monitoring to keep people safe.

There were no cleanliness and infection control audits in place for the provider to monitor these standards in the home. However, we found the home and equipment to be clean. In addition, some renovations had been carried out, with an ill-fitting and difficult to clean linoleum being replaced. One downstairs bathroom had also been renovated. Other renovation work was planned across the home.

People did not have sufficient choice of food to meet their needs. People did not always receive the necessary support to eat and drink, such as preparing food in a suitable way. Although the provider had purchased a hot-food trolley since our last inspection it was not always used appropriately. Food was not always served at the right temperature.

The provider did not yet have effective systems in place to regularly assess and monitor the quality of the services and health and safety. No audits by senior management had been carried out since our last inspection. There remained some health and safety issues outstanding from a previous fire safety audit. However, the provider had purchased a new auditing system which they were due to implement. The serious risks which had not been picked up by the provider’s audits had been rectified. These included the risks of scalding, falling from height and the spread of Legionella infections. The provider had made improvements to the way in which the views of people using the service, their representatives and staff were sought.

The home did not have a person managing the service who was registered with CQC. The new manager had started around a week before our inspection. They have plans to be registered with the CQC.