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Inspection carried out on 11 September 2019

During a routine inspection

About the service

Broadway Nursing is a care home providing personal and nursing care to 41 people living with different health needs, including dementia, at the time of the inspection. The service can support up to 48 people in one adapted, single-floor building.

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

People living at Broadway Nursing and their relatives told us that their experience of using the service was overall positive. Staff planning and deployment to ensure people’s needs were met could at times be improved. We made a recommendation regarding this, as well as staff support through supervision and training, which the registered manager was addressing. The service environment and people’s medicines were overall managed safely, however we identified some improvement needs.

Since the last inspection, the service had introduced new electronic care plans. In a short period of time, staff had transferred existing knowledge of people onto the new documents. These provided rich and detailed information which showed particularly good person-centred knowledge and care. One person told us, “They are not intrusive, but they also always make sure I am ok. They have given me confidence again, which at this stage in my life I think is quite important.”

People, relatives and staff were involved in the development of the service. We heard about a family-like atmosphere. An overall long-standing staff team ensured not just people living at the service were looked after, but their relatives as well. Staff were honest that the new electronic system was a big change for them and not everyone was sure about its benefits. However, staff, along with people and relatives, were also complimentary about the ongoing and reliable support from the well-respected registered manager.

We found that through external learning opportunities the registered manager had developed their confidence and creativity in supporting the team in different ways. They also worked in partnership with a variety of health and social care professionals to achieve positive outcomes for people. This included the registered manager leading a particular project on ensuring good hydration for people. The service listened to people’s thoughts around the food and made changes to achieve continuous improvement. People’s specialist diets, including faith-based requirements, were catered for well.

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.

A new care quality manager was working closely with the registered manager to continuously develop a clearly changing service. Staff were honest about the pressures of their work, but also praised the overall positive, hardworking team morale. This was evident in the improvements that had been achieved, resulting in the service’s first overall good rating

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 requires improvement (published 30 January 2019). At the last the provider was in breach of regulations regarding safe care and treatment. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 7 January 2019

During a routine inspection

This inspection took place on 7 and 9 January 2019 and was unannounced.

Broadway Nursing is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is situated in the Clubmoor area of Liverpool, close to shops, as well as public transport and can accommodate up to 48 people. There were 39 people living at the service when we visited.

At the last inspection on 5 March 2018 we found four breaches of regulations and we asked the provider to take action to make improvements to the safety of the premises, the frequency of staff supervision, promoting people’s dignity and the governance of the service. Following that inspection, the provider sent us an action plan of how they planned to rectify the breaches we found. At this inspection we found their action plan had been followed and three of the breaches had been rectified but further improvements were needed.

At this inspection we found a continued breach of Regulation 12, as doors to rooms containing hazardous items had locks on them, but these had not been used effectively, which put people at risk.

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

The provider had rectified other aspects of the safety of people’s care and treatment, which had previously been in breach of regulations. The provider had identified further measures to make the environment safer for people.

The service’s managers and provider had developed and carried out audit checks to develop the safety and quality of people’s care. The registered manager and care quality manager were working closely to achieve improvements through the use of these checks. Team handovers took place daily to discuss updates and issues, however this needed to be expanded to involve staff members across the service. We found that development needs had been identified, but corrective actions at times needed to be more effective, as some issues were recurring.

We made a recommendation regarding individual staff feedback and performance management as part of effective quality assurance.

We found and reviewed with the team some aspects of record-keeping across the service that needed to be improved to provide consistently safe, quality care for people.

We made a recommendation regarding the use of regular checks.

Improvements had been made across the key questions we ask. However, due to some concerns we could not improve the rating for safe, effective and well-led, as well as the overall rating for the service. We recognised the efforts the registered manager and team at Broadway Nursing had made to achieve these improvements. The team were also aware there was more work to do. We found the staff we met during the inspection warm, welcoming and engaging.

The team was led by a long-standing 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.

People told us they felt safe living at the service and there were generally enough staff to meet their needs. Staff felt short notice absence at times increased their workload. The registered manager was addressing this. Staff had been recruited using appropriate checks.

Risks for people had been assessed and measures had been put into place to help protect them. The registered manager analysed incidents and accidents to learn lessons from what had happened and help prevent reoccurrence. Staff were knowledgeable about safeguarding procedures and concerns had been investigated appropriately.

External and internal audits had identified that aspects of medic

Inspection carried out on 5 March 2018

During a routine inspection

This inspection took place on 5 March 2018 and was unannounced.

Broadway Nursing is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Broadway Nursing provides accommodation, personal care and nursing care for up to 43 adults some of whom have complex needs. The service is situated in the Clubmoor area of Liverpool and is close to shops, pubs and other places of local interest. At the time of the inspection there were 42 people living in the home.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; safe, effective, caring, responsive and well-led to at least good.

A registered manager was 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.

During our last inspection in January 2017, we found that the provider was in breach of regulation 12 because; the environment was not maintained to ensure people's safety. Chemicals were not stored securely, not all fire doors had been adequately maintained and water temperatures were not within safe ranges. On this inspection we found that improvements had not been made to a standard that kept people safe. This meant the provider remained in breach of regulation 12 (Safe care and treatment).

During our last inspection in January 2017, we found that the provider breached regulation 18 because supervisions and appraisals were not completed regularly and not all staff had completed safeguarding vulnerable adults or safe management, storage, recording and administration of medicine training. During this inspection we found improvement to the completion of staff training. However, the supervision matrix provided during the inspection showed that some staff had not received supervision or appraisal as scheduled. This meant that the provider remained in breach of regulation 18 (Staffing).

During the last inspection we found that the provider was in breach of regulation 17 because care files were not always stored securely in order to maintain people’s confidentiality. We also found that care records were lacking in sufficient detail and audit processes had not been effective in identifying concerns and improving practice. As part of this inspection we checked to see if practice had improved.

On our initial tour of the building we were shown into the lounge and saw that two care records had been left unattended on the table and were accessible in the same manner as at the last inspection.

We looked at a total of eight care records. In seven records we found that the care plans held sufficient information to instruct staff and showed evidence that people and their relatives had been involved in the review of person-centred assessments and care plans. However, we also found that care plans for a person who had been admitted five days before our inspection started had not been completed. This meant that care and nursing staff did not have adequate guidance on how to meet this person’s needs.

The registered manager and the care quality manager completed audits on a regular basis. Actions had been identified in relation to a range of subjects. However, some actions had not been completed as scheduled. This meant the provider remained in breach of regulation 17 (Good governance).

We asked people about the food at Broadway Nursing. The majority of people said they enjoyed the food and had a good choice. However, some people commented that the food was not always well-prepared or presented. Improvements to the dining exp

Inspection carried out on 24 January 2017

During a routine inspection

This inspection took place on 24 and 25 January 2017 and was unannounced.

Broadway Nursing is a nursing and residential care home that provides accommodation, nursing care and support for up to 43 adults some of whom have complex needs. The service is situated in the Clubmoor area of Liverpool and was close to shops, pubs and other places of local interest. At the time of the inspection there were 38 people living in the home.

When we last inspected Broadway Nursing in July 2014, the provider was found to be compliant with regulations and the service was rated good in all domains and overall.

A registered manager was 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.

During this inspection we found that risk in the environment was not always minimised. For instance items that could pose risks to vulnerable people, such as razors, were not always stored securely. The door to one person’s room did not close as the automatic closure device was broken. We discussed this with the registered manager and this was repaired by the second day of the inspection. Some radiators around the home were very hot to the touch and could pose a burns risk. Both internal and external checks were completed regularly to help ensure the building and equipment was safe, however water temperatures were not all in safe ranges and were awaiting repair.

Medicines were not always managed safely in the home. Temperatures of the storage room and medicine fridge were meant to be recorded daily, but these checks had not been recorded daily. There were no plans in place to ensure people received medicines prescribed as needed (PRN) when they needed them. Prescribed thickening agents were not signed as administered and recording of allergies was not consistent.

We received mixed feedback regarding staffing levels from relatives and people living in the home, though staff told us there were sufficient numbers of staff to meet people’s needs. Our observations showed us that there were sufficient numbers of staff on duty, but they were not always deployed most effectively.

Staff told us that they received regular training, though not all staff had completed safeguarding training and two staff had not undertaken medicine training or had their competency assessed.

Staff told us that they felt well supported and that they could approach the registered manager if they had any concerns. There did not appear to be programme for staff supervision as they had only been held in January 2016 and appraisals in October 2015. Staff that were new to care had completed an induction which was in line with the principles of the Care Certificate.

Staff we spoke with told us they always asked for people’s consent before providing care. When people were unable to provide consent, mental capacity assessments were completed. Though most of these were completed appropriately, some of the assessments did not follow the principles of the Mental Capacity Act 2005.

Our observations showed that the quality of interactions between staff and people living in the home varied. We observed some very warm and positive interactions during the inspection. However, we also observed interactions that were not as positive.

Care files were not always stored securely in order to maintain people’s confidentiality. This meant that people could access confidential information that did not need to.

We found that although audits were completed to assess the quality of the service, actions were not always taken to address issues they identified. Issues identified through an external service risk assessment had not all been addressed by the provider. The provider was aware of issues within the home through

Inspection carried out on 16 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This was an unannounced inspection.

We carried out this unannounced inspection on the 16 July 2014. The previous inspection was on the 17 December 2013. There were no breaches of legal requirements identified at the last inspection.

Broadway Nursing is a nursing and residential care home that provides accommodation, nursing care and support for up to 43 adults some of whom have complex needs. At the time of this inspection there were 43 people using the service. The service is situated in the Clubmoor area of Liverpool and was close to shops, pubs and other places of local interest.

During the inspection, we spoke with three people living at the service, five relatives of people who were using the service, five care staff, one nurse and the registered manager.

People living at Broadway Nursing were receiving good care and support that was tailored to meet their individual needs. Staff ensured they were kept safe from abuse and avoidable harm.  Restrictions were minimised were possible. People  we spoke with were positive about the service they received. People told us they felt safe and included in decisions about their care.

We found staff were caring and treated people with dignity and respect. People had access to the local community and were supported to go out and pursue individual interests such as going out to attend church, going on days out to various places of interest, going out to lunch or day centres.

The culture within the service was person centred and open. From listening to people’s views we established that the leadership within the service was consistent and the registered manager was readily accessible for staff, people using the service and their families. We found the registered manager took steps to ensure the service learnt from mistakes, incidents and complaints.

Inspection carried out on 17 December 2013

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

We had previously inspected this service on 30 July 2013. During our visit we found that there had been improvements at Broadway Nursing since our last inspection. Medicines were managed safely and effectively and the organisation monitored the quality of the service provided on a regular basis.

Inspection carried out on 30 July 2013

During a routine inspection

During our inspection we used a number of different methods to help us understand the experiences of people living at Broadway Nursing. This was because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke individually with five of the people living there and five of their relatives. We also spent time observing the support provided by staff. We observed staff being kind, caring and respectful at all times in their interactions with the people they cared for. Everyone we spoke with was happy with the care and support provided at Broadway Nursing. Some comments made were:

“They look after you well.”

“The staff are kind and caring.”

“I call the staff angels.”

The people who lived at Broadway Nursing were cared for by staff who were appropriately recruited, trained and experienced at supporting them. However we found that appropriate arrangements were not in place for the management of the medicines and the provider had not always made appropriate safeguarding referrals to the relevant agencies.

Inspection carried out on 12 September 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an 'expert by experience'; people who have experience of using services and who can provide that perspective.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with four people and two relatives during our visit and comments included:

"I knew what I was looking for and we’ve found it here".

"It's really nice here, and I’m now really happy".