Broadmead Rest Home

We found the following examples of good practice:

• The provider had acted to make sure people could have visitors in a safe and comfortable environment. This included purchasing a free standing temperature scanning camera in the entrance to the home to screen visitors effectively for one of the symptoms of COVID-19 and record their visit on a computer.

• The provider had installed a visiting “pod” in the garden which allowed visits to take place in a sheltered, enclosed environment. The two spaces in the pod were separated by a sealed, transparent screen with an intercom for communication between the two sides. This allowed visitors to remove their masks, which helped some people with dementia to engage with their visitors.

• The whole team were committed to keeping people safe during the pandemic. The owner, registered manager, and staff team were all motivated to do the best for people living at the home. Staff had adapted their routines when not at work to reduce the risk of introducing COVID-19 to the home.

• The provider had been proactive in responding to the risk of COVID-19 early in the pandemic. They had anticipated guidance and had started a home lock down before this was included in official guidance. This had reduced the risk of COVID-19 entering the home and kept people safe.

• The provider had acted to make sure new standards of hygiene and cleanliness could be maintained. They had sourced new cleaning products and covered some walls in high risk areas of the home with clear perspex to make them easier to clean thoroughly. This reduced the risk of the virus spreading within the home from contact with surfaces.

Further information is in the detailed findings below.

At the last inspection, in March 2016, the service was rated overall as good, and in the key questions: is the service effective, caring, responsive and well-led. The key question for: is the service safe was rated requires improvement. This was because safe recruitment procedures had not always been followed and where people were prescribed variable doses of medicines, the amounts given were not always recorded. Actions were taken before the end of the inspection process to address the shortfalls we had identified.

We carried out a comprehensive inspection on 7 November 2018. At this inspection, we found the improvements that had been made following the last inspection had been embedded and sustained.

At this inspection, we found shortfalls in the recording of medicines that required additional security.

The service overall, remains Good.

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.

Sufficient numbers of staff were deployed at the time of our visit. Staff performance was monitored. Staff received supervision and training to ensure they could meet people’s needs.

Most medicines management shortfalls were promptly acted upon and actions taken to make improvements. However, there were shortfalls in the recording and checking of some medicines.

Staff demonstrated a good understanding of safeguarding and whistle-blowing and knew how to report concerns.

People were helped to exercise support and control over their lives. People were supported to consent to care and make decisions. The principles of the Mental Capacity Act (MCA) 2005 had been followed.

Risk assessments and risk management plans were in place. Personal and nursing care was delivered in line with assessed needs and accurate monitoring records were maintained.

Incidents and accidents were recorded and showed that actions were taken to minimise the risk of recurrence.

People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.

Staff were kind and caring. People were being treated with dignity and respect and people’s privacy was maintained.

Care was personalised, highly responsive and sensitive to individual needs.

A wide range of activities were offered and provided people with entertainment and engagement in communal areas, in their rooms and outside of the home.

Systems were in place for monitoring quality and safety. Where shortfalls were identified these were acted upon.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We last inspected Broadmead on 2 April 2014 and judged the provider to be in breach of regulations. People who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. We judged that this had a moderate impact on people who used the service, and told the provider to take action. We saw evidence that although work had been completed in relation to the annexe there was no evidence available to confirm that the works completed had met the requirements of the fire department or the health and safety requirements of the local authority. We told the provider to produce an action plan in relation to the safety and suitability of the annexe premises. During this inspection we found the provider had followed their action plan and had made necessary improvements to meet the legal requirements to provide a safe environment for people to live in.

The provider had an emergency business and continuity plan for the home. Fire safety precautions and equipment were checked regularly. Evacuation procedures had been practiced to ensure they were safe and effective. Utilities, such as gas and electricity were routinely checked under contract and the maintenance staff ensured that repairs were completed promptly. Safety tests in relation to the presence of asbestos and Legionella bacteria had been carried out under contract within six months of our inspection.

Not all staff that we spoke with felt that there was always enough staff to meet people’s needs effectively. Some staff told us how they sometimes felt ‘rushed’ and ‘people had to wait longer for assistance at busy times of the day, such as mealtimes'. People and relatives told us staff always responded promptly when required. During our inspection we observed the deployment of staff worked well and people’s needs were met swiftly. Rotas confirmed that there were always sufficient suitably qualified staff deployed to meet people’s needs safely.

Staff had undergone relevant pre-employment checks as part of their application. However, the provider had not always followed safe recruitment procedures by fully exploring gaps recorded in staff previous employment.

We observed medicines administered safely in a way people preferred, by trained care staff who had their competencies assessed annually by the registered manager. However, where people were prescribed medicines to be taken when required, such as pain relief, staff had not always recorded the quantity that they had administered.

People told us they trusted the staff who made them feel safe. Staff had completed safeguarding training and had access to relevant guidance. They were able to recognise if people were at risk of abuse and knew what action they should take if required. Since the last inspection the provider had reported seven safeguarding incidents which had been investigated and reported by the registered manager. We noted that the required learning and appropriate staff supervision had been implemented as a result of these incidents.

People’s needs had been appropriately assessed and reviewed regularly. Their safety was promoted through individualised risk assessments. Where risks to people had been identified there were plans in place to manage them effectively. These plans were responsive to people’s specific needs and tailored the care delivered for each individual. Staff understood the risks to people and followed guidance to safely manage these risks.

People were actively involved in making decisions about their care and were always asked for their consent before any support was provided. Staff supported people to identify their individual wishes and needs by using their individual and unique methods of communication. People were encouraged to be as independent as they were able to be, as safely as possible.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities to protect people. The MCA 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made in their best interests. People were supported by staff to make day to day decisions.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide a lawful way to deprive someone of their liberty, where it is in their best interests or is necessary to protect them from harm. The registered manager had completed appropriate DoLS applications where required, which had been authorised. The registered manager had taken the necessary action to ensure people’s human rights were recognised and protected.

People were provided with nutritious food and drink, which met their dietary preferences and requirements. People were supported to eat a healthy diet of their choice. Where people had been identified to be at risk of choking staff supported them discreetly to minimise such risks, protecting them from harm and promoting their dignity.

People’s health was maintained and any concerns were promptly escalated to health care professionals for advice and guidance. Staff were trained to deliver effective care, and where required, followed advice from specialists for example speech and language therapists, physiotherapists, occupational therapists and community psychiatric nurses.

Staff had developed trusting and caring relationships with people and were able to tell us about the personal histories and preferences of each person they supported. Staff understood people’s care plans and the events that had informed them.

People’s care plans accurately reflected their wishes in relation to the way staff were to support their assessed needs. This ensured people’s care plans accurately reflected their wishes in relation to the way staff were to support their assessed needs.

The provider had deployed sufficient staff to provide stimulating activities for people. The activities programme ensured people were supported to participate in social activities which protected them from social isolation.

People and relatives knew how to complain. People had access to information about how to make a complaint, which was provided in an accessible format to meet their needs. We reviewed five complaints made in the previous year. These had been recorded, acknowledged and investigated in accordance with the provider’s policy, to the satisfaction of the complainant.

The registered manager was highly visible, and promoted a culture of openness where people and staff were encouraged to provide feedback. During our inspection staff demonstrated the values of the provider through their behaviours. Staff were observed to treat people as individuals, with kindness and respect.

The registered manager operated a system of regular audits to assess and monitor the quality of the service provided and to identify and plan required improvements. The provider also employed an external quality assurance assessor who completed independent monthly audits. The registered manager also completed an annual survey to monitor the quality of the service provided.

Records accurately reflected people’s needs and were up to date. Detailed care plans and risk assessments were fully completed and provided necessary guidance for staff to provide the required support to meet people’s needs. People’s and staff records were stored securely, protecting their confidential information from unauthorised persons, whilst remaining accessible to authorised staff.

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-

The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff who supported them and from looking at records. We reviewed twelve people's records; we spoke with six people who used the service, four people's relatives, seven staff and the provider, about the service.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At the inspection on 23 October we found that the provider was not providing a safe environment for people to live in. Following our inspection the provider took action and moved people from the original house to the annexe and limited the number of people they accommodated whilst they completed the required works. We found at this inspection that although the old house was no longer occupied the provider had not taken action to ensure that the required works had been completed so that this part of the home could again be used to provide the regulated activity. We saw evidence that although works had been completed in relation to the annexe there was no evidence available to confirm that the works completed had met the requirements of the fire department or the health and safety requirements of the local authority. We have set a compliance action in relation to the safety and suitability of the premises. We have arranged for the provider to meet with us in order for them to provide us with evidence of how they intend to ensure that the old house will be fit for purpose and will meet the required standard in order to provide the regulated activity.

Systems were in place to receive, store and administer medicines. Records were kept of the medicines administered and supporting information to ensure staff administered medicines consistently. This ensured people received their medicines as prescribed.

We saw that the provider had made improvements to the standard of record keeping and there was overall consistency in the records kept in relation to people's care and staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw evidence that the service was aware of how to make referrals and had done so in the past to help protect people.

Is the service effective?

We found that people's written and verbal consent had been sought in relation to the provision of their care. Where people lacked the capacity to make a decision we saw evidence that best interest decisions had made on their behalf in accordance with the relevant legislation. Staff had received relevant training. We identified areas that the provider could further improve and these were discussed with the provider at the time of the inspection.

People had care plans in place that identified their needs and risk assessments. People had risk assessments in place that there were based on relevant clinical guidance. People's care had been provided as per their care plan. We identified areas that the provider could further improve and these were discussed with the provider at the time of the inspection.

People had nutrition care plans in place and tools had been used to identify when people might be at risk from weight loss. Relevant information in relation to people's dietary needs had been made available to the kitchen staff. We identified areas that the provider could further improve and these were discussed with the provider at the time of the inspection.

Staff had undergone an induction and received ongoing support through the provider's supervision and appraisal process.

Is the service caring?

Staff were observed to be caring and positive in their interactions with people. People we spoke with told us 'I like it here, they are lovely. I think they know my needs.' and 'They are fine, life here is good.' One person's relatives commented 'Staff appear competent and treat everyone with respect.' Another said 'Staff interact well with dad.' People were cared for by staff that were caring in their attitude.

Is the service responsive?

We saw evidence of a recent resident's meeting and following the inspection the provider sent us evidence that their annual survey was about to be circulated in order to seek people's views on the service. People told us 'There's no comparison; it's so much better.' We saw evidence that where people needed to engage with other services such as a GP or dietician arrangements had been made for them to do this. We saw evidence that audits of the service had been completed and used to develop action plans.

Is the service well-led?

There was no manager registered with the Care Quality Commission for this location. We spoke with the provider and we were provided with assurance that the provider had taken appropriate action to ensure that there would be a registered manager shortly. There had been considerable changes at the home in recent months and the provider had to ensure that the changes implemented were sustained. In particular, the service was still undergoing consolidation of the management team. The provider was able to demonstrate to us that they had taken action to ensure continuity for people during this period. A care consultant had been working with the home management for a period of months and we were supplied with evidence that this arrangement was to continue.

Since the previous inspection in October 2013 the operations manager had left the organisation. The home is currently being managed by an interim manager with support from a care consultancy company. At the time of inspection there was no registered manager at this location.

People were mostly asked for their consent before care and treatment was provided. However, we found only one care plan had a consent to care and treatment form completed and signed. Staff had limited knowledge of the Mental Capacity Act and how this impacted upon people who did not have the capacity to make decisions about their care and treatment.

Observation of practices during our inspection showed that most people received effective, safe and appropriate care, which was designed to meet their specific needs. One person said "The staff are good to me and I am extremely happy with my care".

We found that people were not always protected from the risk of inadequate nutrition. This was because actual physical care was not consistent with people's nutritional care plans and information recorded for catering staff when preparing meals.

People who lived at Broadmead Rest Home were protected from the risk of abuse. This was because staff had received appropriate training and understood how safeguarding principles applied to their roles. The people we spoke with told us that they felt safe living in the home.

We found that staff had received suitable supervision and training. There were plans in place for all staff to receive further training and appraisals by 31 March 2014.

Since the previous inspection in June 2013 the registered manager had left the organisation. The home is currently being managed by an operations manager with support from a care consultancy company. There is currently no registered manager at this location.

We found that people were not always cared for in a way that ensured their safety and welfare. One relative told us 'I have noticed a significant deterioration in the standards in the home over the last six months.'At the last inspection in June 2013 the provider was asked to make improvements to achieve the essential standard. At the recent inspection we found that very minor improvements had been made but people still received inappropriate care and treatment.

People told us that they felt safe living at Broadmead Rest Home. We saw records to confirm that not all staff had undertaken safeguarding training. Most staff were unable to tell us how they would report concerns or identify poor practice which could be considered a safeguarding concern. We found that people were not always protected from the risks of injury or harm.

The administration of medications was not conducted or monitored effectively. We found processes which identified that people were not always being given their medication at the correct intervals or at the times prescribed.

Broadmead Rest Home was not adequately maintained and parts of the home were not always fit for purpose. We found people were at risk of falls and injury because health and safety issues were either not identified or addressed.

Staff were not suitably supported to provide an adequate level of care and treatment. At the last inspection in June 2013 the provider was asked to take corrective action in this standard. At the recent inspection we found that very minor improvements had been made. However, staff working in the home had not received an induction, training and supervision to support them in their roles.

There were no effective systems in place to identify, assess and manage the risks relating to health, welfare and safety of people living in the home. The provider had not paid full regard to the the previous CQC inspection report and failed to make the improvements required by the compliance actions.

Records were not accurate and did not protect people from the risks of unsafe and inappropriate care and treatment. Staff provided care for people, which was not as described in their care plan. Records were also inconsistent and staff reported that they were sometimes unclear of the care they needed to provide to people.

We found that people's care plans had incomplete information and risk assessments. The person centred information was also not completed or limited. However, people told us that they felt well cared for. One person told us 'If it wasn't for the staff here I don't know where I would be' and 'They have helped me to enjoy life again'.

People were protected from the risk of abuse. The people we spoke with told us they felt safe living at Broadmead. A local GP told us they had no concerns about the home.

We found that staff were not always supported to provide safe and appropriate care. The manager told us that she observed staff working practices. However, we found that staff did not have regular supervision or an annual appraisal.

The provider asked for people's views and feedback. We saw evidence of positive feedback where people reported the service to be good or excellent.

We found that people were involved in their care planning and were treated with dignity and respect. People said 'staff always, always respect me.' People were encouraged to make their own decisions and choices, where they were able. People told us that staff helped them to make decisions for themselves. Care was planned to meet people's individual daily care and health needs. People told us that they were ''well looked after.''