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We are carrying out a review of quality at Broxbourne House. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 27 February 2017

During a routine inspection

This inspection took place on 27 February 2017. The home was previously inspected in October 2015. At the last inspection we found a breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan telling us about the action they would complete reach compliance. At this inspection we found improvements had been made and the registered manager and provider had worked hard to ensure compliance with the regulations.

Broxbourne House is a care home providing accommodation for 21 older people, some of which were living with dementia. It is situated in Wakefield.

The service had a registered manager in post at the time of our inspection. 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.

People who used the service, who we spoke with, told us they were happy with how care and support was provided at the home. They spoke positively about the staff and the way the home was managed.

We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety.

At the time of the inspection there was sufficient staff on duty to meet people’s needs. Relatives we spoke with confirmed when they visited there were sufficient staff on duty. There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. Staff had received a structured induction into how the home operated, and their job role, at the beginning of their employment. They had access to a varied training programme that met the needs of the people using the service.

Systems were in place to make sure people received their medications safely, which included key staff receiving medication training and regular audits of the system.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People had access to activities and stimulation and this was promoted to ensure people achieved a good sense of well-being.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. However, best interest decision processes were being improved at the time of our inspection.

People’s individualised diets were being met. We received positive comments from people we spoke with about the quality of the food.

People were treated with respect .People and their relatives told us staff were kind and very caring. Staff demonstrated a good awareness of how they respected people’s preferences and ensured their privacy and dignity was maintained. We saw staff took account of people’s individual needs and preferences while supporting them.

There was a system in place to tell people how to make a complaint and how it would be managed. We saw the complaints policy was easily available to people using and visiting the service. The service actively sought the views of people living at the service to continuously improve the service.

There were systems in place to monitor and improve the quality of the service provided. The systems identified any areas for improvement and these were actioned by the registered manager and the provider.

Inspection carried out on 12 October 2015

During a routine inspection

This inspection took place on 12 October 2015 and was unannounced.

We previously inspected the service on 9 April 2014 and at that time we found the registered provider was meeting the regulations we reviewed.

Broxbourne House provides accommodation and personal care and support for up to 21 older people some of who might also have a physical disability and or mental health issues such as people who were living with dementia. At the time of our inspection 21 people were living at Broxbourne House.

The service had a registered manager in place. 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 we spoke with told us they felt safe at Broxbourne House.

There were not always enough staff available to respond to people in a timely manner. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because sufficient numbers of suitably qualified, competent, skilled and experienced staff were not deployed to meet the needs of people who use the service

The registered provider had effective recruitment and selection procedures in place.

Staff had a good understanding about safeguarding adults from abuse and who to contact if they suspected any abuse.

Following incidents or accidents it was not always clear from records what action had been taken to reduce future risks to individuals who used the service.

Whilst most medicines were administered in a safe way for people, some topical creams were not administered as prescribed

People’s capacity was not always considered when decisions needed to be made, for example, when deciding to use a door sensor on people’s bedroom or to share a bedroom with another person. This evidenced a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because consent was not always sought from the relevant person in line with legislation

Staff had received an induction, supervision, appraisal and training to enable them to provide support to the people who lived at Broxbourne House. This ensured they had the knowledge and skills to support the people who lived there.

People enjoyed the food and had plenty to eat and drink. A range of healthcare professionals were involved in people’s care.

Throughout our inspection we observed staff interacting with people in a caring, friendly, manner. Staff were able to clearly describe the steps they would take to ensure the privacy and dignity of the people they cared for and supported.

People did not always receive care that was planned to meet their individual needs and preferences. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s care plans detailed the care and support they required and included some information about people’s likes and dislikes. People and their representatives were involved in care planning and reviews. Activities were provided at Broxbourne House, but this was not at a level which would meet the needs of all the people who used the service.

People told us they knew how to complain and told us staff were always approachable. Comments and complaints people made were responded to appropriately.

People we spoke with spoke positively about the registered manager and the registered provider

The registered manager and registered provider were visible in the service and knew the needs of the people who used the service.

There was an open door to the registered manager’s office and people, staff and visitors had free access to discuss any relevant matters. This helped to create a culture of openness and transparency

The registered manager held meetings with staff, and surveyed the people who used the service, relatives and staff to gain feedback about the service provided to people.

The registered provider had an overview of the service. They audited and monitored the service to ensure the needs of the people were met and that the service provided was to a high standard, however this system had not picked up the problems we found with staffing, administration of topical medicines, consent to care and treatment and person centred care.

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

Inspection carried out on 9 April 2014

During a routine inspection

Broxbourne House is a care home for up to twenty one people and twenty people were living there when we visited. The home provides care and support to older people who have dementia. The home is located in a residential area and accommodation is on two floors.

People who live in the home have varying degrees of dementia. This meant some people were able to tell us their views of the home, while others were unable to communicate this verbally.

People told us they were happy living in the home and felt safe. We saw staff supported people to join in activities and move freely around the home, while at the same time ensuring they and others were kept safe.

There was a range of activities available which people could chose to join in with. We saw staff were kind and caring, treated people with respect and maintained their dignity. This was confirmed by relatives and a reviewing officer from the local authority who we spoke with during the visit.

Staff had received safeguarding training and showed a good understanding of abuse. They knew the procedures for reporting any concerns and had confidence the manager would respond appropriately to any concerns raised. Records showed safeguarding incidents had been recorded and reported to the local authority and Care Quality Commission (CQC). Learning outcomes from a recent safeguarding incident had been shared with staff and improvements put in place.

The manager had a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is law protecting people who are unable to make decisions for themselves. There were no DoLS currently in place, however the manager knew the

correct procedures to follow to ensure people’s rights were protected. Staff had received training in the MCA and DoLS and the manager was organising more indepth training for staff to increase their knowledge

No concerns were raised about the staffing levels and the manager told us staffing levels were kept under review and adjusted according to the dependency levels of people who lived in the home. However, we saw from the duty rotas, there were times when only three care staff were on duty for twenty people. As there were no kitchen staff working at these times this meant the care staff had to serve and clear away the meal as well as provide care to people. We therefore felt the staffing levels should be reviewed as if two staff were assisting one person, only one staff member would be available to support everyone else.

We saw the home followed safe recruitment practices which meant people were kept safe as suitable staff were employed.

People and their relatives told us they had been involved in decisions about their care and were kept informed. Some people were not able to communicate verbally yet we saw staff involved them in decisions and knew how to communicate with them. People told us they enjoyed the food, were given a choice and had enough to eat and drink.

We saw staff took time to explain things so people knew what was happening and enabled people to go at their own pace so they were not rushed. People we spoke with told us the staff knew them well and gave them the support and care they needed.

People’s care records showed their needs had been assessed and were regularly reviewed. Care plans were personalised and up to date. They showed the support people needed and how they wished to be helped in their daily lives.

The manager involved people in decisions about their care but also involved their relatives, as they had often been the person’s carer, and as such provided valuable information and history about the person. The care records reflected this, as did our discussions with relatives.

People we spoke with and their relatives said they felt able to raise any concerns or complaints with staff and were confident they would be acted upon.

Leadership in the home was good. The manager and provider worked alongside staff overseeing the care given and provided support and guidance where needed. Relatives praised the manager and provider, who they said were approachable and listened to their views. One relative said, “They’re both very good and always available. I think they run a good home.”

Staff felt supported and understood the ethos and values that underpinned the care. They felt they could raise any issues and they would be dealt with. One staff member said, “We all work together as a team to give the best quality care possible. If we think we can improve it in any way we just say and they listen.”

There were systems in place to monitor and review safeguarding concerns, accidents, incidents and complaints. The manager told us they monitored staff training using a training matrix, which identified when updates were required through a Red, Amber, Green rating system.

We saw there were systems in place to manage complaints. No formal complaints had been received in the last year. Informal concerns had been recorded and included the action taken in response and how the outcome was feedback to the person who raised the concern.

Inspection carried out on 14 October 2013

During a routine inspection

During our visit we saw that staff treated both service users and their relatives with dignity, courtesy and respect. Staff were seen to knock on doors before entering and provided personal assistance in a kind and discreet fashion.People that we spoke with were very positive about the staff team and in particular the leadership and comments included " nothing is too much trouble".

We observed that staff were polite and interacted well with people. Staff understood the needs of people who lived in the home and supported them in line with guidance in their care plans.

There was a relaxed and comfortable atmosphere within the home and the staff we spoke to understood how to support people, assist them to make choices and maintain as much independence as possible.

In order to protect the people who used the service, we saw that the home carried out a rigorous staff recruitment process. We saw that staff were knowledgeable about peoples needs and treated people as individuals and delivered individual personal care.

People were safeguarded because staff were trained and there were appropriate and robust procedures in place.

People knew who to talk to if they had any concerns about the service and were confident that they would be speedily dealt with.

Relatives we spoke with were unanimous in their praise of the staff and the service they delivered.

Inspection carried out on 18 July 2012

During a routine inspection

People said they like living in the home. People we could not communicate with were relaxed and comfortable. One person said they are very happy and are well cared for. One visiting relative said its like a five star hotel. A visiting National Vocational Qualification assessor from Age UK said they have no issues and the care provided by the home is good. One person said they enjoyed going to the Ballet and to a well known tea room in Harrogate.

Those using the service say they like living in the home and the people caring for them. People said they feel safe and well cared for. One visiting relative said they are very happy with the home and the services it provides.

People living in the home said they are happy with their own rooms. People we could not communicate with were observed relaxing in the lounges and dining room and appeared to be happy and comfortable. One visiting relative said its like living in a five star hotel.

People using the service say they like the people caring for them. People said they are treated with respect and dignity always.

One returned survey from a visiting Social Worker says ‘The kindness, respect and attention to detail shown by the staff is overwhelmingly good and is the main reason why the care provided is so good’. People living in the home say they like the people caring for them. Visiting relatives say the staff are very good and always welcoming. One visiting NVQ Assessor who was observing staff in the home said the staff are very good and deliver a high standard of care.

The returned visitors’ surveys show that people think the staff are approachable and caring. They also say staff are friendly, polite. People using the service say they like the people caring for them.

The returned quality assurance surveys show people are happy with the quality of the care and services provided. People using the service say they like living in the home and the people caring for them.

The returned visitors and service users satisfaction questionnaires show that they know how to make a complaint but have never had to do so. People said if they have any problems they tell someone and it is dealt with right away.

Inspection carried out on 4 February 2011

During a routine inspection

People say they are fully involved in the decision making process and have a say in what they do. People using the service and their relatives say they are involved and their wishes are respected..

They also said are involved and have a say in the running of the home and how they live their daily lives. People say they are well cared for and those caring for them listen to what they say. One relative said the care provided is excellent, the staff are kind and helpful and the meals are very good indeed.

People say they enjoy the meals provided and have a choice of menu people were observed enjoying their lunchtime meal in relaxed and comfortable surroundings. One relative said the meals are excellent and people have a choice of menu. The cook says they spend time with people and get to know what they like and prefer to eat..

One relative said they are fully involved in the assessment and care planning process and sign to say they agree with the way their relative is cared for including their healthcare needs..

People say they like living in a home that is clean. One relative says the home is always spotless and clean.

People say they like the people caring for them as they are caring and helpful. One relative says the staff are great, are very patient and caring. They also said the manager is wonderful and listens to what they say.

People and their relatives say they know how to make a complaint but have never had to do this. One relative says if they have any issues they speak to the staff or the manager and it is sorted out right away. They also say they attend relatives meetings where they can say anything they want.

Reports under our old system of regulation (including those from before CQC was created)