Broughton Lodge

About the service

Broughton Lodge is a residential care home providing accommodation and personal care for up to 20 people. At the time of our inspection 12 people were living at the home. Broughton Lodge is also registered to provide personal care to people living in their own homes; at the time of our inspection one person was receiving personal care in their own home.

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

The service was not consistently meeting the principles of Right support, right care, right culture.

Right Support -

The design of the service and accommodation was not effectively meeting everybody’s needs. Broughton Lodge was institutional in style; it was large and not domestic.

Staff told us many interactions between people who lived at the home were poor and were a significant cause of their anxiety and incidents. The risk that people posed to each other was reduced by staff following strict protocols and at times intervening. However, this did not promote people naturally interacting with each other and having the opportunity to form positive everyday relationships.

Some of the adaptations to the environment had not considered people’s experience.

Some areas of the home were more homely, and people had been supported to decorate and personalise their bedrooms with things that were important to them. Independent advocacy was available for people.

Right Care -

The service operated within the principles of the MCA when supporting people to make significant decisions; using the best interest decision principles. However, in more day to day matters, people’s perspective and opinions were not always sought.

In their interactions staff showed a warm, caring respectful approach towards people. People’s family members told us that their relatives were cared for and treated well. One person’s relative told us, “They seem excellent in caring, genuinely caring and supportive.” Staff spoke to and about people in a dignified and respectful manner; especially when describing times when things have gone wrong.

People received effective and creative support when accessing community healthcare services.

There were a range of initiatives in place that matched different people’s communication styles to help the provider and registered manager listen to people.

Right culture -

Some aspects of the culture within the service were not positive. The service had not consistently promoted ordinary living and had not always dignified people as equal citizens. This was reflected in how the provider had not always considered the experience of people living at the home.

People’s accommodation and care was focused on keeping people safe and was not focused on effectively listening to them and the promotion of people having control over their lives and living an ordinary lifestyle.

Opportunities for learning and improving the care provided were at times lost and not explored or acted upon.

There was evidence that some people had benefitted from the accommodation, care and support provided at Broughton Lodge. Some people had recently moved from Broughton Lodge into their own homes and other people were ready to do this and were planning this move.

Care staff were very positive about their roles. The provider had ensured that a series of checks and audits had taken place at the home to ensure the service provided for people was safe. The registered manager and provider were exploring different ways to support people in the least restrictive manner possible. There had been a recent reduction in physical interventions from staff members.

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

Rating at last inspection and update

The last rating for this service was good (published 9 January 2019).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture.

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 that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the service providing person-centred care and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We made recommendations regarding reviewing incidents and working with stakeholders to review people’s accommodation needs and choices.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Broughton Lodge is a ‘care home’ operated by Cygnet Care Services Limited (the registered provider). People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The care home is set within its own extensive grounds in a rural location in Macclesfield. The care home accommodates up to 20 people across three separate units, each of which have separate adapted facilities. At the time of our inspection, the service was accommodating 12 people with a diverse range of needs.

The care home was registered in July 2015 and had therefore not been developed and designed in line with the values that underpin ‘Registering the Right Support’ and other best practice guidance. Consequently, the service does not currently conform to some aspects of Building the Right Support and Registering the Right Support guidance. For example, the number of registered places and the location of the building.

At the time of our inspection, the care home did not have 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.

A new manager had been appointed to manage the service who had been in post since October 2018. We saw evidence during the inspection that the manager was in the process of applying to CQC to become the registered manager of Broughton Lodge.

The manager was present during the two days of our inspection and was supported by their operations director and deputy manager. The management team were clear about their roles and responsibilities and keen to share developments within the service since the last inspection.

During our site visit, we spoke with staff, people living in the care home, their relatives and representatives. We also undertook direct observations of the standard of care provided. Overall, we noted that staff were sensitive and responsive in their approach to people’s needs and that people were encouraged to follow their preferred daily routines and treated with dignity and respect.

Holistic assessments, care planning processes and risk management systems were in place that confirmed the complex and diverse needs of people using the service were identified, planned for and kept under review. This helped staff to be aware of the support needs of people living in the care home and to understand how best to support them.

People were offered a choice of nutritious and wholesome meals and staff were observed to offer appropriate support and supervision to people who required prompt and support during mealtimes.

Staff had access to induction, mandatory and service specific training to help them understand their roles and responsibilities. This programme of training was in the process of being rolled out to new staff to ensure staff were equipped with the necessary knowledge, skills and understanding for their roles.

Systems had been established to ensure that staff working in the care home had been correctly recruited and to safeguard people from abuse. A complaints policy and process was also in place to ensure concerns and complaints were listened to and acted upon.

Personalised weekly timetables and activity schedules were in place that had been developed for people using signs and symbols. People were supported to access local leisure, recreational and social facilities and to participate in their preferred activities.

People had access to an in-house multi-disciplinary team that consisted of speech and language therapists, occupational therapists and psychologists. People were supported to attend healthcare appointments and staff liaised with people’s GPs and other healthcare professionals as necessary to maintain people’s health and wellbeing. Systems were also in place to ensure medication was monitored and ordered, stored, administered and recorded correctly.

The registered provider had developed a range of governance and quality assurance systems to enable oversight and scrutiny of the service. This involved seeking the views of people who used the service and their representatives.

Broughton Lodge was previously inspected on 3, 7 and 10 July 2017. During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to: staffing; training; recruitment of staff; safeguarding service users from abuse and improper treatment; records; medicine management; cleanliness and infection control; seeking consent in accordance with the Mental Capacity Act 2005; receiving and acting on complaints and governance arrangements. We also found a breach of the Care Quality Commission (Registration) Regulations 2009 as the registered person had not always notified the Commission of incidents or allegations of abuse.

Following the last inspection, the provider was placed into special measures by CQC. We also met with the provider to discuss our findings and asked the provider to complete an action plan to confirm what they would do and by when to improve the five key questions we ask. They are: is the service safe, effective, caring, responsive and well led.

At this inspection we found that the registered provider had taken action to address the breaches identified at the last inspection and made enough improvements to be taken out of special measures.

Broughton Lodge is a ‘care home’ operated by CAS Care Services Limited (the provider). People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The care home is set within its own extensive grounds in a rural location in Macclesfield. The care home accommodates up to 20 people across three separate units, each of which have separate adapted facilities. At the time of our inspection, the service was accommodating 14 people with a diverse range of needs.

The care home was registered in July 2015 and had therefore not been developed and designed in line with the values that underpin ‘Registering the Right Support’ and other best practice guidance. Consequently, the service does not currently conform to some aspects of Building the Right Support and Registering the Right Support guidance. For example, the number of registered places and the location of the building.

The care home 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.

During our two-day inspection, we spoke with relatives, staff and people using the service. We also undertook direct observations of the standard of care provided.

Throughout our inspection we observed that staff treated people living at the home with dignity and respect and were attentive and responsive to people’s needs. People using the service were seen to be relaxed in the presence of staff, comfortable in their home environment and presented as well-groomed and content.

We found that assessment, care planning and risk management systems were in place that confirmed the holistic needs of people using the service were identified, planned for and kept under review. This helped staff to be aware of the support needs of people living in the care home and to understand how best to support them.

Staff had access to induction, mandatory and service specific training to help them understand their roles and responsibilities. Policies and procedures relating to the Mental Capacity Act and Deprivation of Liberty Safeguards had also been developed to provide guidance to staff. Management and staff spoken with demonstrated a good understanding of this legislation and the need to protect the rights of vulnerable people who may lack capacity.

Systems had been established to ensure that staff working in the care home had been correctly recruited and to safeguard people from abuse. A complaints policy and process was also in place to ensure concerns and complaints were listened to and acted upon.

People using the service had access to an in-house multi-disciplinary team that consisted of speech and language therapists, occupational therapists and psychologists. People also had access to a range of health and social care professionals subject to individual need and medication was found to be ordered, stored, administered, recorded and disposed of safely.

A range of auditing systems had been established by the provider so that key aspects of the service could be monitored effectively. Likewise, the provider had implemented a new governance arrangement to ensure improved oversight and scrutiny of the service following our last inspection.

We were informed that the provider had served notices on five people using the service following our last inspection, one of which had since been withdrawn. This was because the provider was of the view that the needs of these people could not be safely met in the care home and had the potential to impact on the safety and wellbeing of other people using the service. We noted that one of the people was still being accommodated in the care home due to difficulties in finding an alternative provider.

The management team acknowledged that the service continued to work through a period of significant transition and demonstrated a commitment to the continuous development of the service. Furthermore, the management team recognised the importance of sustaining the improvements it had made since our last inspection to safeguard the wellbeing of people living in the care home.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures .

This was the first inspection of Broughton Lodge since it was registered in July 2015.

Broughton Lodge provides accommodation and personal care for up to 20 people with autistic spectrum conditions, associated learning difficulties or co-morbid conditions and who are likely to display complex challenging behaviours. At the time of our inspection the service was accommodating 17 people.

There was a registered manager in place at Broughton Lodge. 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 registered manager was suspended from duty in response to concerns identified during our inspection and has since resigned.

During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to: staffing and training; recruitment of staff; safeguarding service users from abuse and improper treatment; records; medicine management; cleanliness and infection control; seeking consent in accordance with the Mental Capacity Act 2005; receiving and acting on complaints and governance arrangements. We also found a breach of the Care Quality Commission (Registration) Regulations 2009 as the registered person had not always notified the Commission of incidents or allegations of abuse.

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.