Broadacres Care Home

Updated 18 March 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type:

Broadacres 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 service did not have a manager registered with the Care Quality Commission. This means that the provider was legally responsible for how the service is run and for the quality and safety of the care provided. A peripatetic manager had been appointed whilst the provider recruited a registered manager. Throughout the report we refer to this person as the manager.

Notice of inspection:

This inspection was announced. We gave the service 24 hours' notice of the inspection.

What we did before inspection

We looked at information we held about the service. This included details about incidents the provider must notify us about, such as allegations of abuse and serious accidents and incidents. We also reviewed all other information sent to us from other stakeholders, for example the local authority and members of the public.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with two people who used the service about their experience of the care provided. We spoke with two members of care staff and the manager.

After the inspection

We continued to seek clarification from the provider to validate evidence found including training data and quality assurance records.

Updated 18 March 2022

About the service:

Broadacres care home is a residential care home providing personal care and support to older people and people living with dementia. There were 25 people using the service at the time of the inspection. The service can support up to 50 people.

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

Management oversight at the service was not always effective. We found audits were irregular and did not always identify issues at the service which required attention. People living at the service and staff had confidence in the manager and the service worked well with other professionals to improve people's care.

Appropriate measures and risk assessments were not always in place to support infection prevention and control to keep people safe. The home environment was predominantly clean and well maintained although some areas required attention.

Risks associated with people's mobility and health conditions had been assessed. People received their medicines safely and there were safeguarding procedures in place to protect people from abuse. People were supported to maintain good health and to eat and drink well. Staff involved other professionals when people became unwell or required additional services

Staff were recruited safely, and pre-employment checks were carried out prior to them commencing work at the service. There were enough staff, day and night, to support people's needs.

Incidents and accidents had been monitored for future learning.

Staff felt supported by the manager. Staff had received supervision to help them in their roles and training had been completed or in the process of being arranged for them.

The manager understood their regulatory responsibilities.

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 requires improvement (report published 25 December 2018)

Why we inspected

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.

Concerns were identified. As a result, we undertook a focused inspection to review the key questions of safe 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 changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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 have identified a breach in relation to good governance. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for 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.