Archived: Broadway Residential

Broadway Residential is a residential care home situated in the middle of a housing estate in a suburb of Liverpool, providing support for up to 17 people. 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. At the time of the inspection, there were 16 people living in the home.

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.

At our last inspection in April 2017 we identified a breach of regulation 12 of the Health and Social Care Act 2008 because; care plans were not in place for all identified health needs to guide staff how to support people with these needs, and risk assessments were not all up to date to enable risk to be monitored and mitigated. Following the inspection the provider submitted an action plan which detailed how they would become compliant with regulation. As part of this inspection we checked to see if the necessary improvements had been made and sustained.

The four care records that we saw had been extensively re-written following the last inspection and in accordance with the timescales submitted in the action plan. Each of them was well-detailed and reflected the full range of people’s care needs including any risk to their health, safety or wellbeing. The provider was no longer in breach of regulation in this regard.

Each of the people we spoke with told us they felt safe living in Broadway Residential. Staff were safely recruited and deployed in sufficient numbers to meet people’s needs and keep them safe.

The staff we spoke with understood their responsibilities in relation to safeguarding people from abuse and neglect. They were able to explain different types of abuse, potential signs of abuse and how they would report any concerns.

Medicines were stored and administered safely in accordance with best-practice. Staff had completed training in relation to safe medicine administration and had their competency assessed to ensure they were sufficiently skilled to manage medicines safely.

The home was clean and free from obvious odours. The risk of infection was reduced because staff had easy access to personal protective equipment (PPE) including gloves and aprons and acted in accordance with the provider’s policy.

We looked at accident and incident reporting within the home and found that they were reported and recorded appropriately. The registered manager maintained a monthly log of all accidents and incidents within the home and reviewed them each month to look for any potential themes or trends.

During the last inspection we identified that records relating to the Mental Capacity Act 2005 (MCA), and in particular capacity assessments were not always completed in accordance with best-practice guidance. We made a recommendation regarding this. As part of this inspection we checked to see if the necessary improvements had been made and sustained.

The records that we saw provided evidence that people’s capacity to consent was assessed appropriately and in relation to a range of decisions.

Staff we spoke with told us they were well-trained and felt well-supported through supervision. They also said they could raise any concerns they had with the registered manager at any time.

People told us they enjoyed the food at Broadway Residential. As part of the inspection we joined people living at Broadway Residential for lunch. The menu offered a good choice of nutritionally balanced meals, and people could request an alternative if they wished.

People living in Broadway Residential were supported by the staff and external health care professionals to maintain their health and wellbeing. The care files we looked at showed people received advice, care and treatment from relevant health and social care professionals, such as the GP, neurologist, dentist, optician and district nurses.

We saw that the provider and registered manager had considered the needs of people living with dementia in the building. Each bedroom door was individually named and painted in a bright colour. Photographs and familiar objects were used to help people identify their rooms. Signage was used throughout the building to help people find toilets and bathrooms.

People spoke positively about the staff and their approach to the provision of care. It was clear from our observations and discussions with staff that they knew people well and were able to respond to their needs in a timely manner.

People told us that friends and relatives were free to visit at any time. Relatives made use of the communal areas, but could also access people’s bedrooms for greater privacy. We saw that some people held a key to their bedroom door and kept it locked when they were using the communal areas.

People’s needs in relation to equality and diversity were considered as part of the assessment and care planning process. All of the people had needs relating to their age. At the time of the inspection none of the people living at the home had specific requirements relating to their culture, sexuality or other protected characteristics. However, a minister came into the home regularly to attend to people’s spiritual needs.

Care files contained a pre admission assessment which helped to ensure that people’s needs were known and could be met effectively from the day they moved into the home. People and their relatives were involved in assessments and care planning.

Broadway Residential employed an activities coordinator to develop and facilitate a range of group and individual activities. Most people spoke positively about the activities available and we saw examples of people taking part.

People had access to a complaints procedure and this was displayed within the home and within the service user guide provided to people when they moved into the home. The registered manager maintained a log of all complaints received as well as any actions taken and the outcome from them.

During the last inspection we identified that audit process had not always been effective in identifying issues of concern. We made a recommendation to improve practice. As part of this inspection we checked to see if the necessary improvements had been made and sustained.

We saw completed audits in areas such as; accidents/incidents, care plans, medicines and infection control. The audits that we saw were detailed and identified actions to be completed to improve safety. For example, the most recent kitchen audit identified that new shelves were required and fridges needed cleaning. These actions had been completed.

We asked people their views of how the home was managed and feedback was positive from people receiving care, their relatives and staff. The registered manager understood their responsibilities in relation to registration with the Commission.

Ratings from the last inspection were on display within the home as required.

Broadway Residential is a residential care home situated in the middle of a housing estate in a suburb of Liverpool, providing support for up to 17 people. It is an old school building converted into a residential care home. During the inspection, there were 15 people living in the home.

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. Feedback regarding the management of the service was positive.

We found that consent was not always sought in line with the principles of the Mental Capacity Act 2005 (MCA). The registered manager was aware this process required improvement and had developed new tools for staff to use. We viewed a completed assessment using the new tool and saw that it followed the principles of the MCA. We made a recommendation regarding this process.

Care plans were not in place for all identified needs and risk assessments had not all been updated to accurately reflect current risk to people.

Systems were in place to assess and monitor the quality and safety of the service and it was evident that actions were taken to address identified issues, however these systems did not identify the concerns highlighted during the inspection.

All of the people we spoke with told us they felt safe living in Broadway Residential and their relatives agreed that they were safe. Staff had completed risk assessments to assess and monitor people’s health and safety. We found that appropriate support was being provided to people to manage identified risk.

Staff we spoke with were knowledgeable regarding safeguarding procedures and how to raise any concerns they had.

We found that medicines were managed safely within the home. A policy was in place to guide staff and staff had received training and had their competency assessed.

We looked at how the home was staffed and found that there was sufficient staff on duty to meet people’s needs in a timely way. We looked at how staff were recruited within the home and found that safe recruitment practices were followed.

Arrangements were in place for checking the environment to ensure it was safe. External contracts were maintained and regular internal checks were also completed to help ensure the building and equipment remained safe. The home was clean and well maintained.

The registered manager had a clear understanding of their responsibility in relation to Deprivation of Liberty Safeguards and appropriate applications had been made.

Staff were supported in their role through regular training, supervision and an annual appraisal and staff told us they felt well supported. A comprehensive induction was in place; however this had not yet been fully completed by new staff.

People told us they enjoyed the food and that there was plenty to eat and drink. The chef and staff were aware of people’s dietary needs and preferences to ensure people’s nutritional needs were met.

People told us that staff were kind and caring and treated them with respect. We observed people’s dignity and privacy being respected by staff in a number of ways, such as staff knocking on people’s door before entering their rooms.

People we spoke with told us that they had choice regarding how they spent their day and care plans we viewed showed that choice and independence were promoted within the home. We observed independence being encouraged during the inspection.

We observed relatives visiting throughout both days of the inspection. The registered manager told us there were no restrictions in visiting, encouraging relationships to be maintained. For people who had no family or friends to represent them, contact details for a local advocacy service were available for people to access.

Care plans in place were detailed and reflected people’s preferences. Not all people we spoke with could recall being involved in the development or review of their plans of care, however they contained information about what was important to the individual and it was clear that care had been discussed with people.

Feedback regarding activities was positive. People told us they enjoyed the activities available.

Systems were in place to gather feedback from people that were relevant to the service. People had access to a complaints procedure and this was displayed within the home. We found that complaints were investigated and managed appropriately and in line with the provider’s policy.

Staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

There were policies and procedures in place to guide staff in their roles and staff we spoke with were aware of these policies and their responsibilities within them.

The registered manager had notified the Care Quality Commission (CQC) of most events and incidents that had occurred in the home in accordance with our statutory notifications.

Ratings from the last inspection were on display within the home as required.

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

People who used services at Broadway were safe within accessible surroundings that were properly maintained. The care home was a converted school but offered appropriate care within a safe environment. There was an effective recruitment process in place which ensured appropriate staff were employed which included a comprehensive induction package alongside on-going relevant training. Records indicated appropriate staff training was being delivered to staff. We found that people who used services at Broadway would, if necessary, have their complaints listened to and acted upon within an acceptable time-scale. There was a system in place to deal with complaints that supported people in the process.