Broughton Lodge

Broughton Lodge is a residential service providing personal care for up to 18 older people some of whom are living with dementia. The service consists of an adapted building, which includes individual bedrooms, communal spaces and an accessible outdoor space. At the time of our inspection there were 16 people using the service.

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

People told us they felt safe with the care and support they received. However, despite mostly positive feedback, we found shortfalls with the management of people’s risks and quality assurance systems which placed people at increased risk of harm.

Systems in place to monitor the quality and safety of the service did not identify and address the shortfalls we found during the inspection.

Not all risks to people had been sufficiently assessed. People received their medicines safely and as prescribed, however we found some minor issues with the management of medicines.

Staff had received safeguarding training and understood their responsibility to report any concerns. Appropriate staff recruitment procedures were in place; however, recruitment records were not always well documented. There were enough staff to keep people safe and meet their needs. Staff followed safe infection prevention and control measures.

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.

Staff told us they felt supported and morale within the staff team was good. People and their relatives spoke positively of staff and told us they were satisfied with the service.

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 February 2019). There have been two targeted inspections since this inspection, published July 2020 and February 2022. These did not change the rating.

At our inspection published July 2020 we recommended that the provider review the published guidance on developing care plans for people with specific behavioural support needs. At this inspection we found sufficient action had not been taken in response to this recommendation.

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

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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 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.

The provider had a visiting policy in place, in line with current guidance. There was a booking system in place for all visitors so that the number of people entering could be managed. A room had been set up for visitors to use and was cleaned after use. This had been discussed with relatives who wanted the arrangements to continue “in order to keep their loved ones safe”. The service remained in touch with the local authority care home support team who provided COVID 19 guidance.

Procedures were in place for staff and visitors, on entry to the service to minimise the risks of infection transmission. This included wearing of personal protective equipment (PPE), checking vaccinations status and a lateral flow testing result.

Regular COVID19 testing was carried out for people and the staff team. The registered manager had clear system and processes in place.

The service had donning and doffing areas set up at entrances to the home and staff were observed wearing PPE appropriately. The service had a plentiful supply of PPE and testing equipment.

Staff received infection prevention and control training. COVID 19 was discussed as part of staff meetings and handovers between shifts. The training included the correct use of PPE and handwashing. The registered manager monitored staff compliance with wearing PPE.

Broughton Lodge is a small residential care home. Some of the people choose to spend their day in their bedrooms. For the others who use the main lounge during the day, whilst social distancing is encouraged, they like to sit together in their preferred armchair.

The service had a number of staff vacancies but had remained well staffed throughout the pandemic. Staff picked up extra shifts and they were able to call on two bank staff if needed. Agency staff were only used as a last resort.

Broughton Lodge Care Home is a residential care home providing personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 18 people.

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

During this inspection people appeared relaxed and had a good rapport with staff. Staff demonstrated a good awareness of the safeguarding processes and felt at ease raising concerns with the registered manager or provider.

At the time of the inspection there were sufficient staff to keep people safe.

The administration, storage and disposal of medicines was managed safely.

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. When people had needed to isolate in their rooms due to the Covid 19 pandemic; best interest discussions had been carried out with people and their families to keep them well informed of the reasons why. One relative told us, “They have been great with communication, I know they would always ring me.”

There was a sufficient supply of personal protective equipment for staff to use, and measures had been put in place to safeguard people from the risk of infection.

We have made a recommendation about the development of challenging behaviour care plans.

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 5 February 2019).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had received about the safe care and treatment of people living in the home. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm relating to the concerns raised. Please see the safe section of this report.

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

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.

Broughton Lodge 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 care home is registered to provide personal care and accommodation up to 18 people. The home specialises in the care of older people including people living with dementia. At the time of the inspection there were 17 people at the home which included people receiving respite care.

At the last inspection in November 2017 the home was rated requires improvement.

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 and well led to at least good. An action plan was received by CQC and at this inspection we saw that actions planned had been put into practice.

At this inspection we found improvements were needed to make sure people received care which was person centred and provided social stimulation. People were not always supported to take part in age appropriate activities. One person said, “There’s nothing wrong with the place. Staff are lovely but I do nothing all day. I do feel lonely but I make the best of it.” One visiting relative said about the activity programme, “This is an area which needs improving.”

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. At the time of this inspection the registered manager was not available but the provider was available throughout the day.

People told us the registered manager was open and approachable and they felt able to raise concerns or complaints. People felt safe and staff knew how to recognise and report any suspicions of abuse. Staff were confident the registered manager would take action to make sure people were protected if they reported any concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Staff worked in accordance with up to date guidance to make sure people’s legal rights were protected.

People told us staff were kind and patient and our observations during the inspection confirmed this. Staff spoke respectfully to people and provided care in an unhurried manner.

People were happy with the food provided and told us there was always a choice of meal. One person said, “We get nice food.” Another person told us, “No complaints about the food.”

People’s health was monitored by staff and people had access to healthcare professionals according to their individual needs. People’s medicines were safely administered and clear records were kept of medicines administered or refused.

The provider was committed to making on-going improvements to the service and facilities offered at Broughton Lodge. There were ways for people to express their views and make suggestions about the home.

Further information is in the detailed findings below

Broughton Lodge provides accommodation and personal care for up to 18 people. At the time of the inspection there were 17 people living in the home and one person staying for a period of respite. The service specialises in caring for older people including those living with dementia. Broughton Lodge is a detached property situated in the town of Burnham on Sea.

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.

Some information relating to staff’s pre-employment checks was not available in staff personnel files.

There was not a crisis contingency plan in place in the event of an emergency and people not able to be accommodated in the home. The director confirmed this was in place following our inspection. Risks to people were assessed, however some of the assessments required additional information.

There were some gaps in staff training and staff required updates in some subjects. Where there were gaps in staff training, these had been identified and future training dates had been arranged for them.

People’s rights were not fully protected because the home had not consistently acted in accordance with the Mental Capacity Act 2005 (MCA).

Medicines were stored safely and securely, the process for administering medicines was not in line with good practice, the director and registered manager amended this during our inspection.

Quality assurance systems were not always fully effective at identifying and addressing shortfalls in the service provided.

People felt safe at the home and with the staff who supported them. Staff were aware of the correct action to take if they suspected someone was being abused. There were adequate numbers of staff available to meet people’s needs in a timely manner.

Systems were in place to reduce the risk of infections and we saw staff had access to personal protective equipment. Incidents and accidents did not occur often in the home, when they did they were recorded by staff. Accidents and incidents did not happen very often however when an incident had occurred, learning from it was shared with the staff team.

Staff monitored people’s health and well-being and made sure they had access to other healthcare professionals according to their individual needs.

People commented positively about the food, people had access to a choice of food and received adequate nutrition and hydration.

Staff received regular one to one supervision and they commented positively about the support they received from the registered manager.

People were supported by staff who were kind and caring. Where people found it difficult to express themselves, staff showed patience and understanding. Staff treated people with respect and dignity.

The home was responsive to people’s needs and people were able to make choices about their day to day routines. People had access to a range of organised and informal activities, people told us they would like to do more art and craft activities and cooking. The director told us they would look into arranging this.

People were able to follow their religious and spiritual beliefs because religious services were held at the home. People and their relatives contributed to the planning of their care. The registered manager was in the process of transferring all of the care plans over to a new format which was person centred.

People and their relatives were aware of the complaints procedure and felt confident to raise any concerns with the registered manager.

There was a person centred and open culture in the home. People, their relatives and the staff commented positively about the management of the home. There was a clear vision and staff were aware of this.

There were systems in place to ensure people, their relatives and the staff were engaged and involved in the home. The home worked in partnership with a range of external professionals.

We have made a recommendation about the service reviewing how they support people in line with the Mental Capacity Act 2005.