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Archived: Broad Acres Inadequate

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Reports


Inspection carried out on 3 April 2017

During a routine inspection

This inspection took place on 3 and 4 April 2017 and was unannounced. At the last inspection on 2 February 2016, we asked the provider to take action to make improvements to the signage and decoration in the service, record keeping and the assessing and how they assessed and monitored the quality of the service. We received an action plan from the provider stating they would meet the relevant legal requirements by 31 May 2016. At this inspection we found that they were still in breach of some regulations. At this inspection we found that although some minor improvements had been made the service still needed to improve further and in some areas had deteriorated.

The service provided nursing care and support for up to 48 people some of whom have mental health needs and others who may be living with dementia. On the days of our inspection there were 34 people living in the service.

The service had a registered manager who was also the provider and clinical lead. 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.

The decoration within the service did not always support the needs of people living with dementia and in some instances was not safe. Quality assurance processes had not identified deficiencies in people’s care plans or shortfalls in the quality of the service provided.

The service did not keep up to date with national safety alerts issued by government. A serious incident had occurred, the circumstances of which had been addressed by an alert. In another case there was no evidence to confirm the service was following safe mouth care practice when an alert had been issued regarding this. People were being placed at an ongoing risk.

Staff did not receive the necessary competency checks. Nurses who had carried out training had not had their competency checked. The registered manager who was also the clinical lead was not aware of their responsibilities in this regard. Therefore people were placed at potential risk of receiving unsafe care and treatment from nurses. Safeguarding training was inadequate to meet the needs of staff as it consisted of a handout and a questions and answers sheet. The service had not introduced the Care Certificate for care staff and therefore the quality of care offered was not as it should be.

An incident which was a safeguarding concern and which was a disciplinary matter had not been recognised as such, reported to the correct authorities or investigated thoroughly. People were not effectively protected from possible harm.

People did not always have their choices and preferences met in how they lived their daily lives. These were not recorded in their care plan and staff did not demonstrate an understanding of the Mental Capacity Act when providing care and support.

Whilst some care staff were observed to provide care and support with kindness and compassion others did not. The approach to care was not consistent and there was no routine monitoring of staff practice to address this. We saw a reliance on staff who were intuitively good carers but no actions in place to support and improve others practice.

Nursing care and clinical governance was poor. The management of pressure ulcers and catheters did not reach required standards. Pressure relieving equipment was not set to the appropriate levels. People were placed at ongoing risk of developing sore skin and not receiving effective treatment for the pressure ulcers they had sustained.

People were not supported with their social needs. The only organised activities observed during the two days of our inspection was a game of skittles.

The leadership of the service was poor. The service quality assurance processes were not used to drive improvement

Inspection carried out on 2 February 2016

During a routine inspection

This inspection took place on 2 February 2016 and was unannounced. Our inspection of January 2015 found that improvements were required in the management of the service. At this inspection we found that there were some improvements but there was still further progress to be made in this area.

Broad Acres provides care and accommodation, including nursing care for up to 48 older people, some of whom may be living with dementia. On the day of our inspection there were 40 people living in the service.

The service had a 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 had a good understanding of what constituted abuse and told us that they would be confident to recognise and report it. Senior staff, including the registered manager, were aware of their roles in relation to reporting allegations to appropriate external agencies. Staff were recruited safely and appropriate background checks carried out.

The registered manager did not have a formal ‘tool’ to assess staffing requirements. People and some staff told us that staffing levels could be stretched particularly at busy times such as in the evening when people wanted support to go to bed.

Risks to people such as falling or acquiring a pressure ulcer were assessed and actions to mitigate the risk put in place. These risk assessments were reviewed regularly and amended where necessary.

People’s fluid intake was not always recorded and monitored effectively. Drinks were not left within easy reach of people to encourage fluid intake. The dining experience was calm and relaxed with staff promoting independence and encouraging people to eat sufficient amounts.

People were supported to access healthcare professionals such as a chiropodist and GP.

People and their relatives, where appropriate, were involved in their care planning. People’s privacy and dignity was now always respected with night staff leaving all bedroom doors open.

The decoration and signage within the premises did not meet the needs of people living in the service, particularly those living with dementia.

The service had made appropriate referrals under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, recommendations by the authorising body had not always been followed. Staff had received training in the MCA but this was not always put into practice.

Care was not always provided in accordance with people’s assessed needs, particularly in regard to those living with dementia. Staff did not always communicate with people in a way which they could fully comprehend.

Resident, relative and staff meetings were not held regularly to ensure that people could express their views and be involved in the development of the service. The manager called a meeting when there was something to discuss.

The service did not implement up to date policies and procedures. Quality assurance audits and internal quality audits were not used to drive improvement in the service.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 27 January 2015

During a routine inspection

This inspection took place on 27 January and 6 February 2015. It was unannounced and carried out by two inspectors.

Broad Acres provides care and accommodation, including nursing care, for up to 48 older people, some of whom may be living with dementia.

There is 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.

There are enough staff to support people safely and staff knew what to do if they suspected someone may be being abused or harmed. Recruitment practices were robust and contributed to protecting people from staff who were unsuitable to work in care. Medicines were managed and stored properly and safely so that people received them as the prescriber intended.

Staff had received the training they needed to understand how to meet people’s needs. They understood the importance of gaining consent from people before delivering their care or treatment. Staff were clear about their roles. Where people were not able to give informed consent staff and the manager ensured their rights were protected.

People have enough to eat and drink to meet their needs and staff assisted or prompted people with meals and fluids if they needed support. However, people’s mealtime experience could be improved, if the meals were less rushed and staff sat next to the people they were supporting to eat. Staff also made sure that people who were becoming unwell were referred promptly to healthcare professionals for advice about their health and welfare.

Staff treated people with warmth and compassion. They were respectful of people’s privacy and dignity and offered comfort and reassurance when people were distressed or unsettled.

Staff showed commitment to understanding and responding to each person’s needs, preferences and histories so that they could engage meaningfully with people. Outings and outside entertainment was offered to people and a staff member offered activities on a daily basis. But the activities they offered were not planned in a way that took into account people’s interests and personal experiences. The activities were generic quizzes that were not smaller groups of people prepared for it and choosing to take part, but the questions were called out to the whole lounge which meant that the majority of people were not involved or engaged by it.

Staff understood the importance of responding to and resolving concerns quickly if they are able to do so. Staff also ensured that more serious complaints were passed on to the management team for investigation. People and their representatives told us that any complaints they made would be addressed by the manager, but that they could be confrontational and argumentative at times. Relatives also told us that the manager will often reprimand staff in front of people and their relatives which they found disturbing and thought it showed disrespect to the staff. Staff confirmed that the manager did this in public areas of the home.

The service has consistent leadership. The manager, who was also one of the providers, took responsibility for monitoring the quality and safety of the service and asked people for their views so that improvements identified were made where possible. The service sought out information from other sources and services to see what would be of benefit in improving the service people received at this home.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Inspection carried out on 16, 23 April 2014

During a routine inspection

The people who used the service were unable to communicate easily verbally. To enable us to assess people’s wellbeing we spent time sitting with them in the lounge and dining area observing the care they received and the level of staff interaction with people. We also spoke with 10 staff members. We looked at five people's care records. We also looked at other records including health and safety checks. During our inspection and the analysis of our inspection findings we considered the questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

We found that the service was safe. When we arrived our identification was checked and we were asked to sign the visitor's book. This showed that the staff took the security of the building and the safety of the people who lived there seriously.

We looked around the property which we found was clean, and free from unpleasant odours. It was well maintained and was a safe environment for the people who used the service.

We saw records which showed that the health and safety checks were carried out in the service regularly and action was taken if equipment was found to be faulty or unsafe. This included regular visual checks and servicing of equipment such as hoists, the fire alarm panel and wheelchairs. Regular fire safety and legionella tests and checks were carried out, which showed that people were protected from unsafe or poorly maintained equipment.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), which was updated every year. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

The service had an effective recruitment system in place and safeguarding checks were carried out on new staff to ensure that they were suitable to work with vulnerable people.

Is the service effective?

The majority of the people who used this service were living with dementia and were unable to communicate their needs. However, the staff we observed showed a good understanding of people’s needs and demonstrated that they had built up good relationships with the people they supported. This ensured that the staff knew the person they were caring for and that people were being supported in a way that would protect their health, wellbeing and independence.

We were able to speak with three people. They told us that the staff treated them well and worked hard. One person said, "I’ve no problems, they (the staff) look after me well.” Another person told us, “I have no grumbles."

During our observations of the care and support given to people, we saw that the service was effective in meeting people’s needs.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We saw that the service was effective in assessing people’s nutritional needs and offered a good and varied menu, while ensuring that health needs and preferences were met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, respectful and professional manner. Not all the people were able to talk with us, but during the time we spent at the service we saw staff were committed to caring for the people they supported.

We spoke with three people and they told us that the staff were kind and considerate.

Is the service responsive?

We saw evidence that the service was flexible and made changes as required to ensure people were kept safe. People's care records showed that where concerns about their health and wellbeing had been identified, the staff had taken appropriate action to ensure that people were provided with the support they needed. For example, they sought support and guidance from health care professionals, including the doctor, the speech and language team and the dietician.

The people who used the service, their relatives and other professionals involved with Broad Acres were given the opportunity to complete annual satisfaction questionnaires. The manager said that the service responded to concerns raised with them. This would ensure that the quality of the service was maintained.

Is the service well led?

The service had an effective quality assurance system in place and the records we examined showed that identified shortfalls were addressed promptly.

Concerns had been shared with us that the manager’s communication style was not always conducive to good staff relationships. The staff we spoke had mixed views about their management style, but told us that they had found them mainly supportive.

Inspection carried out on 21 August 2013

During an inspection to make sure that the improvements required had been made

We carried out this inspection to check that the service had taken action to become compliant in an area they were not compliant in during our last inspection on 6 June 2013. We had found that, although the majority of people were provided with suitable and nutritious food and drink, the dietitian’s advice was not always followed for those people who needed extra support to maintain their weight. We found that the service had taken action to become compliant with this outcome.

We looked at people’s care plans as concerns had been raised with us about their quality. We found that they needed to be updated and rewritten as the provider had written them when people were admitted to the service, and added to them as needed to update them. Some people who had used the service for many years, essentially still had the original plan from when they first moved in.

We did not talk with people who used the service on this occasion; we concentrated on checking records and talking with the manager and staff.

When we last visited the service on 6 June 2013 we observed the delivery of care and spoke with three people. We saw that the staff were attentive and interacted with the people who used the service in a friendly, respectful and professional manner.

People told us that the staff knew how they wanted to be supported and that they made sure they got what they needed. One person said, "It’s good here." Another person told us that the staff ".... are only ever kind."

Inspection carried out on 6 June 2013

During a routine inspection

We talked with three of the people who used the service. They told us that they liked living there, that the care staff showed them respect and looked after them well. They also told us that they were comfortable. One person told us, "I have nothing to complain about." Another person told us that they were happy with the service they received and that, "The people here are fine."

The majority of people who lived in Broad Acres were living with dementia and were unable to tell us about the quality of care they received. To enable us to access people's wellbeing we spent time sitting with them observing the care they received and the level of staff interaction.

We observed that the staff were attentive to people's needs. Staff interacted with the people who used the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance.

We saw that the majority of people were provided with suitable and nutritious food and drink, however the dietitian’s advice was not always followed for those people who needed extra support to maintain their weight.

We looked at three staff files and found evidence that showed that the staff received supervision and training necessary to effectively care for older people.

We looked at the way that complaints were recorded and dealt with, and saw that they were handled in line with the provider's policy.

Inspection carried out on 8 November 2012

During a routine inspection

We spoke with six people who used the service, one person's relative, four staff members and a visiting health professional.

People who used the service told us that they were satisfied with the service provided. One person said, "I am very happy living here." Another person said, "I am happy, the carers are very kind."

People told us that they were provided with choices of meals that were of good quality and that they were provided with enough to eat and drink. One person said, "I had a lovely meal thank you." Another said, "The food is good." Another person said, "They (staff) always make sure I have a fresh jug of water in my room."

A person's relative told us that they felt that their relative's needs were met. They said that they and their relative were consulted about the care provided and the staff were respectful in their approach.

A visiting health professional told us that the service provided, "Good care." They also told us that the service made appropriate referrals for health care support.

We tracked the care records of three people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights.

Inspection carried out on 21 February 2012

During an inspection to make sure that the improvements required had been made

During our visit to Broadcares we had mixed reposes from people, some people told us that they were not happy living at the home and four people were visibly upset whilst we were undertaking our visit.

Other people told us that “the staff look after me well” and the “carers all do a marvellous job”

Inspection carried out on 25 November 2011

During a routine inspection

People using the service told us that they were “happy”, “get treated well” and the “staff are very good”.