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Inspection carried out on 14 December 2018

During a routine inspection

The inspection took place on the 14 and 17 December 2018 and was unannounced.

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 w

Inspection carried out on 8 January 2018

During a routine inspection

The inspection took place on the 8 and 9 January 2018 and was unannounced.

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.

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Inspection carried out on 3 July 2017

During a routine inspection

This inspection was unannounced and took place on the 3, 7 and 10 July 2017.

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.