Broadoak Lodge

Broadoak Lodge is a residential care home providing personal care to up to 27 people in one adapted building. The service provides support to older people including those living with dementia. At the time of our inspection there were 21 people using the service.

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

People and their relatives told us there were enough staff to meet their daily needs in a timely way.

Some staff raised concerns over the number of staff deployed for one shift. The number of staff deployed on this shift was increased.

We have made a recommendation about staffing.

Staff received regular training and supervision. Safe recruitment processes were in place and appropriate pre-employment checks were completed prior to staff starting employment.

People and relatives told us the service was safe. People were protected from the risk of abuse, and staff understood safeguarding procedures and how to raise a concern.

People and relatives told us staff were kind and caring. Staff knew people well and held positive relationships with them. Personalised care plans included details of people’s wishes and preferences.

People’s care needs were assessed, and risk assessments were in place for staff to support people safely.

The service was welcoming. Everyone we spoke with told us managers and staff were approachable and friendly. The manager was a visible presence in the service offering guidance and support where needed.

The service worked in partnership with other agencies and health professionals to ensure people received joined up care.

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.

People received their medicines as prescribed. Infection prevention and control procedures were in place and the environment safely managed.

Quality assurance systems were in place to monitor the quality of the service. Regular audits were carried out to ensure prompt action was taken following any shortfall identified.

The provider and manager were open and transparent and responded promptly to feedback during the inspection.

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 good (published 1 December 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook a focused inspection to review the key questions of safe, caring and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained the same based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Broadoak Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ Staff had received training in the use of personal protective equipment (PPE), and we saw this was accessible throughout the home. Staff used it in accordance with the most up to date guidance.

¿ There was a clear process for visitors, which included a temperature check, the wearing of PPE and designated visiting areas. At the time of the inspection, visits for all but health care professionals had been suspended due to a recent outbreak and national lockdown. People were supported to maintain contact with friends and family through social media and telephone calls.

¿ Cleaning schedules had been increased to ensure touch surfaces were cleaned regularly and additional cleaning to maintain good hygiene standards.

¿ The registered manager held regular meetings and ensured any new guidance was shared with staff. Individual risks for staff had been identified and assessed and they were supported through regular supervision, competency checks and an 'open door' policy.

¿ People were provided with regular information and updates which enabled them to choose where and how they wished to spend their time.

¿ Staff promoted and practised safe social distancing throughout the home as far as is reasonably practical. Clear systems were in place to shield and isolate people during outbreaks.

¿ People and staff were regularly taking part in the COVID testing programme. People's consent was sought through best interest decisions. People, relatives and staff were kept well informed on the need for testing and any changes in infection prevention and control guidance.

¿ The infection control policy was up to date. We reviewed audits which reflected actions had been taken to maintain the standards within the home.

Further information is in the detailed findings below.

Broadoak Lodge is registered to provide accommodation and personal care for up to 27 adults. At the time of our inspection there were 24 people using the service.

People’s experience of using this service:

Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report these types of concerns. People had risk assessments in place to enable them to be as independent as they could be in a safe manner.

Staff knew how to manage risks to promote people’s safety, and balanced these against people’s right to take risks and become more independent. There were sufficient staff with time to support people with their required needs and take part in activities of their choice.

Effective recruitment processes were in place and followed by the management team and provider. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people from cross infection.

People were supported to make decisions about all aspects of their life; the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards underpinned this. Correct processes were in place to protect people. Staff gained consent before supporting people and respected their decisions.

People were encouraged to have choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice.

Staff received an induction process and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. Staff were also supported by managers through supervisions.

People could make choices about the food and drink they had, and staff gave support when required to enable people to have a balanced diet. People were supported to access a variety of health professionals when required, including opticians and doctors to make sure people received healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained. Care plans were written in a person-centred way and were responsive to people’s needs. People were supported to follow their interests.

There was a complaints procedure which was accessible to all. Complaints had been responded to appropriately. Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

The registered manager managed the service. The assistant manager was in the process of applying to be a registered manager also.

Rating at last inspection:

At our last inspection we rated the service as requires improvement in the domains of Safe and Well-Led. This report was published on 02 February 2018. At this inspection we found evidence that these ratings were now good.

Why we inspected:

We carried out this inspection based on the service's previous rating. At the last inspection we found three breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The service was rated Requires Improvement in Safe and Well-led. We required the service to make improvements and the provider informed us what they would do to meet the regulations.

More information is in the full report.

Follow up: We will continue to monitor the home in line with our regulatory powers.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Broadoak Lodge on our website at www.cqc.org.uk.

We carried out this focused inspection on 16 November 2017 and the inspection was unannounced. Broadoak Lodge is a care home without nursing and provides care and support for up to 27 older people including people living with dementia. At the time of the inspection there were 25 people using the service.

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.

There were not always sufficient numbers of staff to meet people’s needs or to keep them safe.

Staff knew how to recognise the signs of abuse and what action to take should they suspect it. However, the registered manager failed to report a serious allegation to the local authority safeguarding team or to the CQC. This meant that people may not always be protected from abuse.

People told us they received their medicines in the right way and at the right time. We saw that staff followed correct procedures for the safe administration of medicines. However, where medicines were prescribed on an as required basis, there was insufficient instruction to staff about when this medicine should be given. This meant there was a risk of inconsistency as to the amounts of medicines given.

Risks were assessed and management plans were in place to reduce the risk. For example, some people had a pressure mat that alerted staff when they stood up if there was a risk they would fall. However, because staffing levels were not always sufficient to meet people’s needs there was a risk there may not be enough staff to respond to the pressure mat alarm. In particular there were instances of only two staff members being on duty at night. If both of these staff members were attended to a person that required two staff to help them mobilise then there were no staff available to respond to or monitor other people’s needs.

Daily health and safety checks were carried out on the premises and environment. Routine maintenance and safety checks were also carried out such as checking hoists and electrical and gas appliances were safe to use. However, routine maintenance work on the hot and cold water systems had not been carried out since January 2017 despite the providers own policy stating this should be done every two weeks. Staff had not had a fire drill since our last inspection.

Quality monitoring did not effectively identify issues or lead to improvements. People and staff felt supported by the registered manager and felt they were approachable and accessible. We identified that improvements were required at our comprehensive inspection in April 2017 but action had not been taken to improve.

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

service.

There was a registered manager in post. It is a requirement that the service has 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.

Staff understood their responsibilities about protecting people from abuse and avoidable harm. Risk was assessed and management plans were put in place.

Some people said they had to wait a long time for staff to attend to them. Other people said that staff responded promptly when they called for assistance. We have made a recommendation about the deployment of staff.

Pre employment checks were carried out so that so far as possible only staff with suitable character and skills were employed.

People's medicines were managed, stored and administered in line with current professional guidance. Staff were not following the protocol for an 'as required' medicine for one person. Action was taken to address this during our visit.

Staff had received training and support to carry out their roles, and knew how to meet people's individual needs. Consent was sought in line with legislation and guidance.

People were supported to eat and drink a varied and nutritious diet. They had access to the healthcare services they required.

Staff were caring and had developed positive relationships with people. People had their privacy and dignity respected.

Care and support was delivered in the ways that people preferred. People felt comfortable making a complaint and confident they would be listened to.

The culture of the service was open and inclusive. There was a clear organisational structure and staff understood their responsibilities. The quality of the service was monitored and changes were made to continually improve.

At the last inspection on 3 and 4 December 2015, we asked the provider to take action to make improvements to the safe care and treatment for people who used the service, safeguarding people from abuse and improper treatment, staffing, good governance and notifying us of events that happened at the service. We found that most of these actions had been completed. We received information from the provider about how they would address these concerns on 10 February 2016. This identified work that had been undertaken and the planned works to improve the service.

Broadoak Lodge is a care home registered to provide accommodation for up to 27 older people who are living with dementia, or who have a learning disability or autism spectrum disorder. On the day of our inspection 23 people were using the service.

The service does not have 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.’ A registered manager from another service had been covering the post full time and had been since March 2015. The manager told us that they were in the process of applying to become the registered manager for Broadoak Lodge.

People were now protected from the potential for harm from the actions of other people living in the service. Most risks had been assessed. Guidance had been provided for staff on how to manage risks that people may display. Staff were following this guidance. However people were not consistently protected from risks relating to their health and safety. Staff were not always following risk management plans that were in place.

People were protected from abuse. Where incidents had occurred they were recorded on 'incident report' forms. However details of the investigation had not been recorded on these forms. Policies had been updated and staff were aware that they could raise any concerns with outside agencies.

Staffing levels had been increased since our last visit, though people sometimes had to wait for their needs to be met. Staff had been recruited using recruitment processes to make sure that staff were suitable to work with people who used the service.

People’s tablets and liquid medicines were handled safely and were given to them in accordance with their prescriptions. Where some people had cream prescribed for them we found that staff were using creams that had been prescribed for other people. We found that where this was happening the creams being used were not always the prescribed cream.

Checks and risk assessments to make sure the building was safe had been completed. Evacuation plans had been written for people to help support them safely in the event of an emergency.

Staff received support through an induction to the service and supervision. There was an on-going training programme to update staff on safe ways of working. However, we found that staff had not been trained fully to meet the needs of people who used the service. Training records showed that night time staff had not been trained to administer medicine.

People were supported to access healthcare services when they needed them. However, the provider did not always ensure that advice given by health professionals was followed.

Where people’s food intake needed to be monitored to reduce the risk of malnutrition the amount of food people had been given was not recorded.

Staff told us that they sought people's consent before the provided care and support. Some people were subject to restrictions in order to keep them safe and meet their care needs. The manager had made sure that these restrictions were in people's best interests and had followed the correct process to put these in place.

People received support from staff that seemed kind and patient. People had been involved in developing their own care plans.

People’s dignity and privacy was not respected. Work that was due to be completed by the end of February 2016 to develop a new bathroom had not been carried out at the time of our visit. Following this inspection we have received confirmation from Leicestershire County Council that the work has now been completed. People were using other people’s bathing facilities. Action that had been identified to improve the quality of the experience that people living in the service received had not been completed.

People received care and support that was usually based on their preferences. Care plans provided information about people and their histories so that staff knew about people and what was important to them. People did not always participate in reviewing their care plans. People took part in some activities.

People were asked for feedback on the quality of the service that they received. People knew how to make complaint and a procedure was displayed in the service.

Records relating to people’s care were not fully completed and contained contradictory information. This meant that were could not be assured that people received the care they needed. We found that checks that had been implemented to monitor this had not identified the concerns that we found.

The provider had implemented systems and processes to monitor and improve the quality of the service that had been provided. These did not identify concerns that we found during this visit.

We found one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have systems in place that monitored the quality of the service and effectively identified concerns that we found during this visit. You can see what action we told the provider to take at the back of the full version of the report.

At our last inspection of the service, 27 and 28 August 2015 the provider was failing to meet two regulations. These related to governance and safe care and treatment. We issued the provider with a warning notice in relation to governance at the service and told them that they needed to improve. We also issued them with a requirement notice relating to providing safe care and treatment at the service. At this inspection we found that the provider had failed to address all of the concerns and we identified further concerns about the health, safety and wellbeing of people at the service.

Broadoak Lodge provides accommodation, care and support for up to 27 people who require personal care. On the day of our inspection 25 people were using the service. There should be a registered manager at the service. 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 service did not have registered manager in post although a registered manager from another of the provider’s services was working at the service.

People were not consistently protected from risks relating to their health and safety. Risks had not always been assessed. Where there was guidance in place for staff to follow to reduce risks associated with people's care this was not consistently followed.

People were not protected from abuse. People were made to get up early, sometimes up to four hours before their preferred time to rise, without any choice and this was abusive. Allegations of abuse and safeguarding incidents had not been reported or investigated appropriately and so people had been denied the oversight and protection of the council and the Care Quality Commission.

People told us that the staff were kind and caring. However, we found that people had to wait for their needs to be met as there were not sufficient staff at the service. Staff did not have the time to get to know people and respond appropriately to meet their needs. People did not always receive choices or communication from staff about how and where they spent their time.

People were at risk of not receiving their medicines as prescribed. This included medicines prescribed for severe heart, eye and metal health conditions. There was not always clear guidance for staff to follow to ensure that people received their medicines when and how they needed them. Some staff who were expected to administer important medicines had not received training on how to do so and did not have ready access to them. Recordings of the administration of medicines were inconsistent.

People received care from staff that had undergone the appropriate pre-employment checks. Staff had not all received appropriate training and support to enable them to fulfil their roles. Night staff on duty for example had not received any training from the provider in relation to their roles, including their responsibilities to administer important medicines and to use necessary moving and handling equipment.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). Where there was a reasonable doubt that a person lacked capacity to make decisions the service had a mental capacity care plan in place. However, the information relating to the people’s mental capacity was not decision specific and therefore did not fully meet the requirements of the MCA legislation. The service had taken appropriate steps where they had identified that people were being deprived of their liberty in any way and they had made referrals to the local authority as is required.

People enjoyed the meals they were offered. Drinks and snacks were available throughout the day. People were not always however supported to maintain a balanced diet when they needed assistance or supervision.

People were supported to access healthcare services but the provider did not always ensure that advice given by health professionals was carried out.

People’s needs had been assessed and care plans were in place with the intention of people’s needs being met. On a day to day basis people were not supported to take part in social activities. Activities did not reflect people's individual hobbies and interests.

The provider had taken some action to improve the systems and processes in place to assess and monitor the quality of service. However the action they had taken had not been closely monitored for its effectiveness and we continued to identify a number of areas where improvements had not been made.

We identified that the provider was in breach of four of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see at the end of this report the action we have asked them to take.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found that there may not always be enough staff on duty with the required skills and experience. There were a high number of un-witnessed falls recorded. Some staff had not received all the training they required to do their jobs nor had not had their training updated.

People who used the service, their relatives and staff were not asked for feedback or for their views about the care and support provided. The acting manager could not find any record of quality monitoring carried out at the service in the last six months. We saw that accidents and incident were recorded but we could not see any evidence of action taken to reduce risk.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time

People were given choice and autonomy over their lives. There was a varied range of recreational and social activities. Staff interacted with people who used the service in a kind and respectful manner. We observed staff and explaining what they were doing and working in an unhurried way in order to reassure and meet individual need.

Staff were knowledgable about people's individual needs and about the providers policies and procedures. The manager sought advice and guidance from appropriate professionals when this was required.