Archived: Broadlands Nursing Home Ltd

Broadlands nursing home is a residential care home providing personal and nursing care to 13 people aged 65 and over at the time of the inspection. The service is registered to support up to 25 people. However, currently their maximum occupancy is 18 people as they are only offering rooms for single occupancy in response to the COVID-19 pandemic.

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

There were not sufficient staff to meet people’s needs. Copies of rotas and feedback from staff confirmed that at times the service was not staffed at the provider’s assessed level to support people’s needs, particularly at night. People fed back that they felt there were not enough staff to provide them with timely support.

Staff were not up to date with their mandatory training and the staff did not feel adequately supported. The staffing pressures at the service impacted on the ability of staff to undertake their required duties.

Risks to people’s safety were not adequately assessed and mitigated. This included environmental risks such as the risk of falling from height from an unrestricted window, the risk of burns from freestanding heaters and the risk of poisoning from access to harmful chemicals. People’s care records did not provide clear and accurate information about how to support people to manage individual risks, and we saw that one person was not supported to reposition as frequently as their care plan stipulated to reduce the risk of pressure ulcers developing.

There were systems in place to review the quality of service delivery. These systems had identified some of the concerns we found during inspection. This included some of the environmental risks and lack of compliance with the provider’s mandatory training. However, action had not been taken in a timely manner to address these concerns. In addition, the checks had not identified all of the concerns we found during inspection. Therefore, we could not be assured that the systems in place were adequate to review the quality of all areas of the service and ensure people’s safety.

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. Staff involved people in their care. They were aware of what decisions people had the capacity to make and supported them in line with their preferences. We observed staff providing support in a caring and compassionate manner. Staff supported people to access healthcare services and to ensure their nutrition and hydration needs were met. Safe medicines management practices were in place and people received their medicines as prescribed.

Staff were knowledgeable of safeguarding adults procedures and reporting processes should any incidents or accidents occur. Staff adhered to government guidance about how to protect people from the risk of infection in relation to the COVID-19 virus. There was a commitment within the staff team to improve practices and provide high quality care, but some of the systems in place at the time of inspection were creating barriers to this.

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

Rating at last inspection

The last rating for this service was good (published 8 November 2017).

Why we inspected

We received concerns in relation to staffing levels, staff training and management arrangements. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing levels, staff training and governance at this inspection. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Staff were supporting people to stay in touch with friends and family. A dedicated visiting area had been designed for people to receive visitors safely and reduce the risk of transmission of COVID-19. For friends and family unable to visit the home, staff supported people to have video calls to maintain their relationships.

Staff adhered to government guidelines regarding the use of personal protective equipment (PPE) and there were dedicated areas for staff to don and doff (take on and take off) PPE. Staff were provided with uniforms to further reduce the risk of transmission of COVID-19.

Staff and people were supported as much as possible to social distance throughout the service. Communal areas had been redesigned to enable people to sit further apart. Staff breaks had been reorganised to ensure staff were able to have their break whilst still socially distancing from one another in staff rooms.

Staff adhered to government guidelines during an outbreak of COVID-19 in the home and followed advice given. The staff raised concerns about managing transmission of the virus for people who posed additional risks, for example, people who walked with purpose. They were seeking support and guidance from the care home support team and challenging behaviour team.

Staff and residents were being regularly tested for COVID-19. Staff sought consent from people, or people authorised to make decisions on their behalf, about participation in testing. The majority of staff and people had also received their COVID-19 vaccinations.

Policies and procedures were in place regarding infection prevention and control (IPC) and a regular IPC audit was carried out. Some environmental improvements were required to enable enhanced cleaning due to general wear and tear and a redecoration programme had begun.

Further information is in the detailed findings below.

Although not a breach of the regulations we also found staff had not received all the necessary training and support required to help them carry out their work effectively. Audits and quality checks had not been effective in identifying and addressing shortfalls we found at the service. There was no registered manager in post. Policies and procedures to help staff deliver consistent care had not been updated since 2010.

We carried out a focused inspection in January 2017 to check the provider had taken the action they said they would to meet legal requirements in relation to the breaches of regulation. We found some improvements had been made. A cooling device was installed in the room where medicines were stored and sharps bins containing hazardous items were no longer kept in communal bathrooms and toilets. The provider had also introduced an accidents and incidents register to help identify underlying causes or trends which may have contributed to these. We also found the provider was meeting legal requirements where people had been deprived of their liberty as part of their care, to help ensure this was in their best interests and as least restrictive as possible. However we found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to the safe care and treatment of people. The restrictors on the window at the top of a communal staircase were still unsuitable which meant people were still at risk of falling from height. We served a warning notice on the provider and asked them to make the necessary improvements by 17 February 2017. We also found gaps again in recruitment records which meant the provider was still not assuring themselves of staff’s suitability and fitness to support people. You can read the reports from our previous inspections, by selecting the 'all reports' link for Broadlands Nursing Home on our website at www.cqc.org.uk

Broadlands Nursing Home provides personal and nursing care for up to 25 people. At the time of our inspection there were 18 people using the service some of whom were living with dementia.

At this inspection we found the provider had taken action to meet legal requirements and had made improvements. The window at the top of the communal staircase was now fitted with a robust restrictor which meant the risk of people falling from height from this window had been reduced. Recruitment records showed the provider was carrying out appropriate checks and obtained the necessary evidence to assure themselves of staff’s suitability and fitness to support people.

Since our last inspection the provider had made further improvements to other aspects of the service. Records maintained about accidents and incidents had been updated to provide better insight into people’s behaviours so that appropriate action could be taken to reduce risks to their, and others, health and safety. The provider had improved training and supervision (one to one meeting) arrangements so that staff were better supported to help them meet people's needs more effectively. The provider had also reviewed and updated the service’s policies and procedures to bring staff up to date with information and guidance they needed to help them deliver consistent working practices.

A registered manager was now in post. 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 and relatives spoke positively about them and the management of the service. Staff felt well supported by the registered manager and by the rest of the senior staff team. The registered manager was aware of their role and responsibilities particularly with regard CQC registration requirements and their legal obligation to submit notifications of reportable events or incidents at the service.

Arrangements to audit and check the quality of the service had been strengthened. In addition to regular audits and checks of key aspects of the service, weekly audits of medicines had been introduced to pick up any issues or concerns more quickly. The registered manager used improved management information to check and review progress being made to meet required standards across the service. The provider continued to check the quality of the service through monthly provider level visits and monitored that required improvements were actioned.

People were safe. There were enough staff to meet people’s needs. Staff knew how to protect people from the risk of abuse or harm and followed appropriate guidance to minimise identified risks to people’s health, safety and wellbeing. The premises and equipment were maintained and serviced to ensure these were safe. The provider was taking action at the time of this inspection to improve fire safety at the home. The environment was clean and staff followed good practice to ensure risks to people from poor hygiene and cleanliness were minimised.

People had support plans which set out their care and support needs. These were reviewed regularly by senior staff. Staff knew people well and how they wished to be supported. People were prompted to make choices and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were supported to eat and drink enough to meet their needs and to access healthcare services when needed. They received the medicines prescribed to them. The provider ensured medicines continued to be stored safely and securely and that the service’s policy and procedures in relation medicines reflected current best practice and legal requirements.

Staff were caring and treated people with dignity and respect. They ensured people's privacy was maintained particularly when being supported with their personal care needs. People were encouraged to do as much as they could and wanted to do for themselves to retain their independence. Staff encouraged people to participate in activities and events to meet their social and physical needs and reduce risks to them from social isolation. Staff were warm and welcoming to visitors to the service.

People and relative’s feedback indicated a high level of satisfaction with the care and support provided at the service. The provider sought their views and suggestions for how the service could be improved. The provider maintained arrangements to deal with people's complaints appropriately if these should arise.

Some improvements had been made to the environment to make Broadlands Nursing Home a more comfortable place to live. New carpet had been laid in some parts of the home and the ground floor communal bathroom was being refurbished. However some aspects of the environment required more care and attention to detail. We saw some of the information about the service displayed around the environment was not always easy to read. We discussed what we found with the registered manager who welcomed our feedback and said they would review the environment and the way information was displayed to make this more relevant and accessible to people at the service.

Broadlands Nursing Home provides residential and nursing care for up to 25 people. At the time of our visit there were 16 people using the service. 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. 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.

At our last inspection on 14 July 2016 we found three breaches of legal requirements in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, and fit and proper persons employed. The provider wrote to us with their action plan on 25 August 2016 and told us they would resolve these issues by 17 October 2016.

The purpose of this inspection was to check the improvements the provider said they would make in meeting legal requirements. At this inspection, we found that although the provider had made some improvements to the safety and quality of the service, they were still in breach of the regulations in relation to safe care and treatment and fit and proper persons employed.

Upper floor windows at the top of a communal staircase were still not fitted with appropriate restrictors to protect people from risks associated with falling from height. The restrictors in place were not tamper-proof and could be easily removed.

The provider was still not obtaining all of the information about staff that is required by law as part of recruitment procedures. They did not have appropriate systems in place to ensure a full work history was obtained for each member of staff.

We are taking further action against the provider for a repeated failure to meet the regulation in relation to safe care and treatment. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The provider had made some of the improvements that were necessary since their last inspection. They installed a cooling device to help ensure the room where medicines were kept was cool enough to store medicines safely. They also moved bins containing used razors from bathrooms into a secure room where people could not access them. They had put in place an accident and incident register that helped the registered manager identify any trends in accidents and incidents to help prevent reoccurrence.

The provider had taken action to ensure they were meeting legal requirements when people were deprived of their liberty as part of their care. They applied in a timely manner to the relevant bodies when they required authorisation to deprive people of their liberty and where these were granted, staff made sure they met any conditions attached to the authorisations. This helped to ensure restriction or deprivation of people’s liberty was in their best interests and as least restrictive as possible.

Broadlands Nursing Home provides personal and nursing care for up to 25 people. At the time of our visit there were 19 people using the service. The service did not have a registered manager in post although a manager had been recruited and was due to commence work shortly. 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.

Although people and their relatives felt that the service was safe, the provider did not always identify and manage risks to people’s safety. For example, there were not sufficient measures in place to prevent people falling from upper floor windows or coming into contact with used razor blades. Medicines were not always stored safely because the temperature in the clinical room was too high. There was not an effective system to monitor accidents and incidents, identify themes and ensure appropriate action was taken. The provider was aware of this shortfall and was working towards putting such a system in place.

We also found that the provider did not always carry out the necessary checks on staff to ensure they were thoroughly vetted and of good character before their employment started.

When people were deprived of their liberty as part of their care and treatment, the provider had not ensured they were adhering to the requirements of the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

We found three breaches of regulations during the inspection. These were in regards to providing safe care and treatment, fit and proper persons employed and safeguarding people from abuse and improper treatment. You can see the action we have told the provider to take with regard to these breaches at the back of the full version of this report.

Equipment such as hoists and fire safety equipment were regularly checked and serviced to ensure they were safe to use. People had individual risk assessments and management plans to keep them safe from risks specific to them. There were enough staff to meet people’s needs and keep them safe. Apart from the high storage temperature, the provider managed medicines in a safe way.

Staff obtained people’s consent before delivering care and when people did not have the capacity to consent to their care, the provider acted within legal requirements.

Staff received a variety of training and support to carry out their roles effectively. However, there was insufficient evidence that new staff and night workers received enough training and formal support for this.

People received a choice of nutritious food and drinks and their nutritional health was monitored appropriately. However, action taken by staff to ensure people ate healthily was not always recorded in care plans to ensure consistency in the delivery of care.

Staff were caring and respectful. People and their relatives told us the service was caring and they got on well with staff. Staff took time to get to know people and their communication styles and gave them appropriate support to make decisions about how their care was provided. Staff kept people informed about what was happening in the home. People told us staff respected their privacy and dignity.

People received personalised care that was responsive to their needs, because care plans took into account people’s background, health conditions and preferences. Records showed people were supported in line with their care plans. The provider took steps to protect people from the risk of social isolation and provided a variety of group and individual activities that were appropriate to people’s needs, preferences and abilities. Staff considered people’s religious and spiritual needs when providing care.

People and their relatives fed back that the provider responded appropriately to their concerns. We saw evidence that the provider dealt with complaints promptly and to people’s satisfaction.

The provider involved people, their relatives and staff in decisions about how the service was operated and any proposed changes that affected them. People, their relatives and staff felt that managers were approachable and they were able to express their opinions. The provider regularly asked people and their relatives for feedback to help them improve the service.

The provider had plans in place to develop and improve several aspects of the service and used monitoring visits and audits to monitor progress. However, the provider’s audits were not always effective as they did not identify all of the issues that we found at our inspection. We also found the provider’s policies were not regularly updated and had not been reviewed to ensure they remained consistent with current best practice guidance.