The inspection took place on 6 and 7 June 2017 and was unannounced.Broomfield Lodge provides accommodation and personal care for up to 24 older people and people living with dementia. The service is a large converted property and accommodation is arranged over two floors. A lift is available to assist people to get to the upper floor. The service has 21 bedrooms, seven of the bedrooms have ensuite toilets. There were 20 people living at the service at the time of our inspection.
There was a registered manager working at the service. 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 and associated Regulations about how the service is run.
We last inspected the service in April 2016. We found shortfalls in the service. The provider had failed to store medicines safely, had not accurately recorded the application of creams and had not checked staff competency regularly to assess that medicines were administered safely. The provider had failed to develop a care plan for each person, which included ways in which the person preferred their care to be provided and how they could maintain their independence.
We asked the provider to provide an action plan to explain how they are going to make improvements to the service. At this inspection we found that improvements had been made.
Each person had a care plan that had been written with the person and their relative, giving details of how they like to be supported with their care. There was detailed guidance for staff to follow to provide consistent and safe care, staff were knowledgeable about people’s preferences and described how they supported people following the guidance in the care plans.
People’s medicines and creams were stored safely. There were accurate records of where and when the creams had been applied. Medicines were stored at the recommended temperature to ensure the medicines remained effective. People received their medicines when they needed them from staff trained and competent in the safe administration of medicines.
People told us they felt safe living at the service. Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. Some risk assessments were not detailed enough to ensure that all staff were providing support in a safe and consistent way. Staff told us how they provided support to people and this was safe and consistent. During the inspection the registered manager completed new detailed risk assessments. We have made a recommendation that risk assessments should include more detail.
Staff completed checks on the environment, to ensure people were safe. Accidents and incidents were recorded and analysed to identify any patterns or trends to mitigate the risk of them happening again.
Staff knew about abuse and knew what to do if they suspected any incident of abuse. Staff were aware of the whistleblowing policy and the ability to take concerns to agencies outside of the service. Staff were confident that any concerns they raised would be investigated to ensure people were kept safe.
People received effective care from staff who had the knowledge and skills to carry out their roles. Staff were knowledgeable and were able to tell us and we observed how they put their training into practice. Staff understood their roles and responsibilities, the management team worked with staff to ensure they were competent in their roles. Staff told us they felt the management team was approachable and supportive.
The registered manager followed the provider’s recruitment policy to make sure that staff were of good character. Staff completed regular training, had one to one meetings and annual appraisals to discuss their personal development.
There were consistent numbers of staff employed to meet people’s needs. At the last inspection, people told us that they were not able to always get up when they wanted to and had been an area for improvement. At this inspection, the registered manager had altered the shifts staff worked so there was an extra member of staff early in the morning to support people who wanted to get up early.
The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. Staff knew the importance of giving people choices and gaining their consent.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications for DoLS had been made in line with guidance.
People enjoyed a choice of healthy, home cooked meals. People told us they enjoyed the meals and they had enough to eat and drink. People’s health was assessed and monitored and staff took prompt action when they noticed any changes or decline in health. Staff worked closely with health professionals and followed the guidance given to them to ensure people received safe and effective care.
People told us that they were treated with kindness and compassion. Their privacy and dignity were respected. Staff knew people well and spoke with them in a kind and patient way. People were encouraged to express their views and opinions and these were respected by staff.
People knew how to complain and told us that they have no complaints about the service. The provider had a complaints policy and procedure.
People’s family and friends could visit when they wanted and there were no restrictions on the time of day. People were encouraged to be as independent as possible. There was a choice of activities for people to join in if they wished, some people preferred to follow individual hobbies and this was respected.
The registered manager and staff had a clear vision for the service. The registered manager had an ‘open door’ policy; people and relatives told us the management team were approachable and supportive.
People and staff felt the service was well-led. There was effective regular auditing and monitoring, any shortfalls were addressed and resolved quickly. People, relatives and health professionals were asked for their views on the quality of the service provided.
The provider had submitted notifications to CQC in a timely manner and in line with CQC guidelines.