Broomfield Residential Care

Broomfield Residential Care is a residential care home that can provide care and support for up to 40 people, including people who may be living with dementia. At the time of the inspection 32 people were using the service. Accommodation is provided over the ground and first floors with various lounge and dining areas and a garden room.

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

People received safe care and support and they told us they felt safe living at Broomfield Residential Care. Staff understood safeguarding procedures and were confident in reporting any concerns. Risks to people's safety were assessed and well managed, and people’s care plans detailed current risks and individual needs.

There were sufficient numbers of staff who were safely recruited to meet people's needs. Staff received training in relation to the safe administration of medicines and their competencies were checked to ensure safe practice. Infection control measures were robustly followed, and staff had access to sufficient PPE.

People's care needs were assessed before they went to live at the service, to ensure their needs could be fully met. Staff received an induction when they first commenced work at the service and ongoing training that enabled them to have the skills and knowledge to provide effective care.

People were supported to eat and drink enough and staff placed a strong emphasis on the dining experience to ensure it was enjoyed by all. Staff supported people to live healthier lives and access healthcare services.

The service had a vibrant and welcoming atmosphere where visitors were welcomed and encouraged. The premises was homely and adapted to meet the needs of people using the service.

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 were supported by kind, caring and compassionate staff that often went the extra mile to provide people with good quality care. The staff team were passionate about providing people with support that was based on their individual needs, goals and aspirations.

An activities programme was in place, and care plans were personalised to each individual detailing their likes, dislikes and personal preferences. People and their family were involved in the care planning process as much as was possible. A complaints system was in place and was used effectively. There was no one receiving end of life care at the time of our inspection. However, there were systems in place to care for people at the end of their life with support from other health professionals.

The service was well managed. People, relatives and staff were very positive about the leadership of the service and praised the management team highly. There were systems in place to monitor the quality of the service. Actions were taken and improvements were made when required. Staff felt well supported and said the registered manager was open and approachable. The service worked in partnership with outside agencies.

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 (published 04 September 2020)

Why we inspected

We undertook this focused inspection to check if improvements had been made since the last inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Broomfield Residential Care 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.

Broomfield Residential Care provides accommodation and personal care for up to 40 individuals aged 65 and over including those requiring specialist dementia care. At the time of our inspection there were 23 people using the service.

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

Improvements had been made to the management of people’s medicines so that they received their medication safely.

Cleanliness, hygiene and infection control practices had been enhanced to ensure a good standard of cleanliness to protect people from the risk of the spread of infection.

Care plans had been reviewed and were being continually updated to include more personalised information with regards to people’s hobbies, daily routines and the gender of staff to support them. Care plans contained Information about people’s likes and dislikes and daily routines.

People's privacy, dignity and independence was fully respected and promoted by staff. We observed staff interactions at lunch time which were positive, kind and caring.

There was a registered manager who had been in post for four months. They demonstrated a good knowledge of dementia care and had made numerous improvements at the service. Relatives and staff were positive about the registered manager who they described as visible, approachable and had an open-door policy.

The provider's quality assurance systems and processes had been reviewed and improved to ensure they were effective and gave the registered manager and the provider a good oversight of the service. Audits and daily visual checks were carried out by the registered manager. The provider also undertook a weekly walk around the service with the maintenance person so any areas that required improvement could be swiftly addressed.

The provider had made significant improvements to the environment. Dementia friendly signage had been put in place around the premises to help people with their daily orientation and help reduce confusion. Handrails both inside and outside had been installed with contrasting colours used to distinguish the handrails from the wall.

Extensive refurbishment of the service had taken place and was on-going in the older part of the building. This area of the service was closed and there was no one living in this part of the building at the time of our inspection.

Processes were in place to protect people from avoidable harm and abuse. Staff were aware of their responsibilities in relation to this and were clear about the way to escalate any concerns they identified.

Risks to people’s safety were assessed and strategies were put in place to reduce the risks. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.

Sufficient staff were available to provide a timely response to people and provide safe care. Staff had been employed following robust recruitment checks.

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 (published 26 March 2020) and there were two breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out a comprehensive inspection of this service on 14 January 2020. Two breaches of legal requirements were found. We issued one warning notice and one requirement notice. We asked the provider to complete an action plan after the last inspection to show what they would do and by when, to improve safe care and treatment, and good governance.

We undertook this focused inspection to check that the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions, not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement.

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.

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

Broomfield Residential Care is a care home providing personal 30 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

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

People’s wellbeing and safety was placed at risk as care was not always taken when people received their medicines. Cleanliness, hygiene and infection control practices were not always maintained to a good standard to protect people from the risk of the spread of infection.

People were not actively encouraged to be involved fully in planning and reviewing their care. People’s care plans had been updated although in some instances lacked personalisation with regards to their hobbies, daily routines and the gender of staff to support them. People’s privacy, dignity and independence was not fully respected and promoted by staff. We observed some positive interactions and kindness shown by staff towards people.

The service had a registered manager. Whilst they understood their legal responsibilities they had not kept their knowledge up to date in relation to best practice guidance in relation to medicines management and infection control practices.

The provider’s quality assurance systems and processes remained ineffective and lacked oversight. Audits and daily visual checks were carried out daily by the registered manager did not identify the issues we found in relation to hygiene, cleanliness, environmental risks. Information in the care plans varied and lacked about individual preferences and daily routines. People, their relatives and staff were not confident their concerns would be taken seriously. They found the registered manager was neither visible or approachable.

People’s views about the staffing numbers were mixed despite the increased numbers of staff on duty. Although people said their needs were met staff were often stretched at busy times and relied on the activities coordinator to supervise people in the communal lounge.

Staff recruitment procedures were followed, and all necessary pre-employment checks were carried out. Staff received training for their roles and were supervised.

People told us they felt safe and were confident staff would protect them from avoidable harm. Staff were trained in safeguarding procedures and knew how to raise concerns. Risks to people’s health, safety and welfare was assessed, managed and monitored. Where we found missing associated risk assessment regarding nutrition, the senior carer assured us this would be addressed. Care plans provided guidance for staff to follow to meet people’s needs.

The garden room was used by people as they liked to listen to the sounds of the outdoors and birds. Ongoing refurbishment of the home, décor and new en-suite bedrooms. Further improvements to the adaptations could improve people’s sense of wellbeing with clear signage to access different areas of the home. There was no contrasting colours used to distinguish the handrails from the wall. The outdoor paved area was used by people.

People were provided with enough to eat and drink. People’s dietary needs were mostly met to ensure risks were managed and to maintain good health. People’s health care needs were met, and they had access to a wide range of healthcare support. Procedures were followed to ensure people had the opportunity to express their wishes in relation to end of life care.

People were mostly 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.

The activities coordinator with the support of the provider had improved the range of activities offered to people. They included group and individual activities and a selection of games, puzzles and books but not always age appropriate. People’s relatives and friends were welcome to visit anytime. The service had maintained links with the wider community.

People had opportunities to express their views about the service through surveys and more recently the ‘residents’ meetings. People and their relatives knew how to make a complaint and were confident to speak with the care staff and the provider.

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 (published 17 January 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence the provider needs to make improvements as two breaches were found in relation to people’s safety and quality assurance systems to monitor the care, environmental risks and the effectiveness of audits. Please see in Safe, Effective, Caring, Responsive and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to people’s safety and the provider’s quality monitoring systems and processes at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The home is registered to accommodate 50 older people some living with dementia and mental health difficulties; at the time of our inspection, there were 30 people living in there.

At our last inspection in May 2017, this service was rated overall as good. We had received information that the service may have deteriorated and decided to undertake a Responsive inspection on 26 and 28 November 2018. At this inspection, we found that the service had deteriorated and has been rated as requires improvement. This is the third time the service has been rated as requires improvement in the last three years.

The first day of the inspection was unannounced.

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 is not always sufficient staff deployed to provide care safely in a timely way. People are left waiting for assistance at times. There is limited opportunity for people to follow their interests or take part in meaningful activities which would keep them more active and mentally stimulated.

People’s choices are limited and their preferences are not always considered. Their dignity is not always protected.

The systems in place to monitor the quality of care and effectiveness of the service are not always effective and fail to pick up some of the shortfalls in the quality and standard of care being delivered.

Staff undertake all relevant training but not all staff demonstrate their knowledge and understanding in practice.

Risk assessments are undertaken and plans put in place to mitigate the risk identified. However, the information recorded to mitigate the risk is not always sufficiently detailed to ensure people are cared for safely.

People receive care from staff that know them and are kind and compassionate. The staff are friendly, caring and passionate about the care and support they deliver. People have formed positive therapeutic relationships with staff and are treated as individuals.

Staff understand the need to undertake specific assessments where people lack capacity to consent to their care and/or their day-to-day routines and staff support people in the least restrictive way possible; the policies and systems in place in the service support this practice.

Care plans are in place, which enable staff to provide consistent care and support in line with people’s personal preferences and choices, however this need improving to ensure more detail is captured and kept up to date. End of life wishes are discussed and plans put in place when required.

People are cared for by staff who demonstrate an understanding of each person’s needs. This is evident in the way staff speak to people and engage with them. Relatives speak positively about the care their relative receive and feel they can approach management and staff to discuss any issues or concerns they have.

Staff are appropriately recruited. People receive their prescribed medicines safely. Staff understand their responsibilities to keep people safe from any risk or harm and know how to respond if they have any concerns.

People’s health care and nutritional needs are carefully considered and relevant health care professionals are appropriately involved in people’s care. Family and friends are welcome at any time and encouraged to take part in any social events at the home.

People know how to raise a concern or make a complaint and there is an effective system in place to manage any complaints that may be received.

Broomfield is purpose built and there is development and refurbishment programme in place. We have recommended that the provider seeks advice as to the best design to make the home more dementia friendly.

At this inspection, we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

Broomfield Residential Care is located in the village of Olney in Buckinghamshire and is registered to provide accommodation and personal care. They are registered for up to 50 older people who may also be living with conditions such as dementia. On the day of our inspection there were 37 people living at the service.

The service has 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 and associated Regulations about how the service is run.

People felt safe. Staff had been provided with training to enable them to recognise signs and symptoms of abuse and they knew how to report any concerns. People had risk assessments in place to enable them to maintain their independence and keep them safe. Adequate staff with the appropriate skill mix were available to support people with their needs. Effective recruitment procedures were in place to ensure suitable staff were employed to work with people using the service. Systems were in place to ensure that medicines were managed safely. This ensured that people received their medicines at the prescribed times.

Staff received appropriate training, supervision and support to enable them to carry out their roles and responsibilities effectively. People’s consent to care and treatment was sought in line with the principles of the Mental Capacity Act (MCA) 2005 legislation.

People were able to make choices about the food and drink they had and to maintain a healthy and balanced diet. Staff supported people to access a variety of health professionals including the dentist, optician, chiropodist, dietician and the speech and language therapist.

People and their relatives commented positively about the standard of the care provided. Staff provided care and support in a meaningful manner; and knew about people’s preferences and personal histories. People’s views were listened to and they were actively encouraged to be involved in their care and support. Staff ensured that people’s privacy and dignity was upheld. Any information about people was respected and treated confidentially.

People’s needs were assessed before coming to live at the service and the care plans reflected how their needs were to be met. People were supported to take part in activities and there was an activities programme in place. There was a complaints procedure in place to enable people to raise complaints.

There were effective management and leadership arrangements in place. Systems were also in place to monitor the quality of the service provided. Action plans were in place and were updated after checks and audits, to help further develop the service. The registered manager also submitted statutory notifications to the CQC when required.

We carried out an unannounced comprehensive inspection of this service on 10 August 2016 and identified six breaches of legal requirements. We issued the provider with a warning notice for two of these breaches and they wrote to us with an action plan explaining how they would meet the other requirements. On 13 December 2016, we carried out a focused inspection to see whether the provider had followed their improvement plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Broomfield Residential Care on our website at www.cqc.org.uk.

During the inspection on 10 August 2016, we found that risks to people were not always well managed. Risk assessments were not always specific and did not contain guidance for staff regarding how they could reduce risks. Risk monitoring was carried out, such as regularly weighing people, however; there was a lack of action taken in response to changes in the levels of risk to people. We also found that areas of the service were not always clean and free from the risks associated with infection control. There were not effective cleaning schedules or logs in place to ensure cleaning was carried out as required.

We also found that people did not always receive sufficient food and hydration to meet their needs. We saw that where people had lost weight, the service had not always taken action to manage that weight loss or to refer people to appropriate healthcare professionals. In addition, people did not always receive person-centred care, which was tailored to meet their individual needs and preferences. Care plans did not always have specific information about how people wanted their care to be provided and there was a lack of stimulation and activities to keep people occupied.

Quality assurance procedures at the service were not effective and did not help the registered manager or provider to have oversight over the care and support being provided. The systems which were in place had failed to highlight areas for development, which meant improvements were not being driven at the service. The registered manager and provider had also failed to send statutory notifications to the Care Quality Commission (CQC) for some incidents of abuse or suspected abuse.

We asked the provider to take action in response to our concerns around risk management and quality assurance by 31 October 2016. The provider sent us an action plan to tell us how they would meet our other concerns and stated that they would be meeting these legal requirements by 31 October 2016. During this inspection we returned to see if the service had made the improvements we asked for and they stated in their action plan. We found that the provider was now meeting these regulations.

The service 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.

Improvements had been made to the systems in place for assessing and managing risks to people. Risk assessments were more comprehensive and contained specific information and guidance for staff, which helped them manage risk. Where risks had been identified, such as in relation to weight loss, action was now taken promptly to mitigate that risk and to try to help people's conditions improve. Improvements had also been made to the systems for nutrition and hydration to ensure that people had the meals and nutritional supplements they required to help them stay as healthy as possible. Where necessary, support from healthcare professionals had been sought.

The provider had introduced improved systems for managing the cleanliness of the service. Additional cleaning staff had been recruited and robust cleaning logs and checklists were in place, to help guide staff and to demonstrate which areas of the service had been cleaned and when.

Care was now more person-centred. Care plans had been reviewed and updated to ensure they contained accurate and relevant information. They were more specific to each individual and provided staff with detailed information which they could use when providing people with care. More emphasis had been placed on activities and engagement for people, which helped to provide them with greater levels of stimulation.

Improvements had also been made to the quality assurance processes at the service. A range of checks and audits were carried out by staff, the registered manager and the provider, to check the care that was being provided. Action plans were in place and were updated after checks and audits, to help further develop the service. The registered manager also submitted statutory notifications to the CQC when required.

Broomfield Residential Care is registered to provide accommodation for people who require personal care for up to 50 older people who may also be living with dementia. On the day of our inspection there were 37 people living at the service.

Prior to this inspection we received some information of concern about the care that people were receiving at the service. We were told that there were concerns around infection control practices at the service and that some areas were not always kept clean. We were also told people did not always receive personalised care which was in accordance with their own needs and wishes and that activities were not sufficient to provide people with enough stimulation. We carried out this comprehensive inspection to check these areas and to inspect the whole of the service.

The service 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.

The service had not always taken steps to manage risks to people's health and well-being. There was on-going monitoring of key information regarding people's health however; action was not always taken in response to changes. Risk assessments were also in place in people's care plans, but they failed to reflect these changing conditions, or provide staff members with information about what they could do to reduce the impact of those risks.

There were areas of the service which had not been cleaned effectively. There was not a system in place to ensure that staff members knew what cleaning should be conducted and when. In addition, there were no checks carried out to ensure that cleaning had taken place and to identify areas where additional cleaning was required.

People were not supported to have a suitably nutritious diet to help them maintain good health. Some people at the service had lost weight over a number of months and action had not been taken to prevent further weight loss. Food offered to these people had not changed to help them gain weight and referrals to healthcare professionals had not taken place. The provider did not have systems in place to ensure that people received the care and support that they needed, and that their health and well-being were promoted.

Care was not always person-centred. Care plans were in place however they were not always reflective of people's current needs and wishes. They were reviewed on a regular basis however; changes were not made to them to ensure they were updated as people's needs changed. People were not provided with regular activities or supported to engage in their hobbies or interests to keep them stimulated. Staffing levels were sufficient to meet people's care needs, but not to ensure that they had the opportunity to engage in activities or to spend time talking and relaxing with members of staff.

Quality assurance processes were carried out however; they were not effective in monitoring the service and identify areas where improvements were required. There were no action plans in place to demonstrate that action was being taken to develop the service.

Staff members did not always feel they received formal support from the service. They received regular supervision sessions but did not feel they were able to raise issues and explore their development needs. Training courses were mainly carried out by distance learning courses which some staff did not feel provided them with the same opportunity to learn as other training methods.

People felt safe living at the service. Staff members were trained in recognising potential abuse and took action to prevent it occurring. Accidents and incidents, including potential abuse, were recorded and reported appropriately. Staff members also supported people to take their medication safely and in accordance with the prescriber's instructions.

Staff members sought people's consent before providing them with care and support. If people were unable to provide consent the service worked with their family members to make a best interests' decision, in accordance with the principles of the Mental Capacity Act 2005.

People were supported to make and attend appointments with their GP and other healthcare professionals both within the service and the local community.

There were positive and meaningful relationships between people and members of staff. Staff got to know people as individuals and were willing to engage with people. They tried to ensure that people were as involved as possible in the planning of their care and provided them, and their family members, with information about the service and what they could expect from the service. Staff upheld people's privacy and dignity at all times.

Comments and complaints about the service were encouraged and there were systems in place to receive feedback from people and their family members. If complaints were made, the service took steps to deal with them and arrive at a suitable outcome.

There was an open and positive ethos at the service. Staff were keen to perform their roles and ensure that people received the care that they needed. They were willing to speak up if they were unhappy with the care that people received, to help ensure that people were safe and well cared for.

We identified that the provider was not meeting regulatory requirements and was in breach of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive to people's needs?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

Because of people's complex needs we were unable to speak with all of the people who used the service, however we observed that everyone appeared happy. We noted they were comfortable in the presence of any of the staff, including the registered manager and the provider.

Person centred care plans and individual risk assessments were being improved and updated to electronic versions. The new system would support staff to ensure they included specific detail within care records. The intention was that staff would be clearly guided to deliver consistent care and ensure that people were protected from harm.

We found that there was a robust system in place to make sure that the manager and staff learnt from events, including accidents and incidents, health and safety issues, complaints and concerns. This meant that the risk of harm to people was reduced. In addition, the service was able to evidence its plans for future improvements.

Is the service effective?

We saw that people were supported, within the confines of their health and medical condition, to be involved in their care planning. For example, where possible they had stated their preferences, particularly in relation to their food likes and the gender of the staff providing their care.

Staff we spoke with had a good understanding of people's needs and knew how they preferred to be supported. This meant people were supported appropriately in relation to their needs

We observed staff responded promptly to people's needs and call bells were not left unanswered. We saw that care plans had been updated when people's needs had changed, and referrals had been made to other health and social care professionals when needed to ensure best care.

Is the service caring?

During our visit we observed positive interactions between the staff and the people who used the service. People were supported and spoken to in a kindly manner by all of the staff. One person said, 'Everyone is nice, they look after us.' We saw a number of cards from the relatives of people using the service that thanked the staff for their care and attention. A relative told us that they felt welcome in the home at any time.

The staff we spoke with had good knowledge about people's medical conditions and needs and would seek advice and support appropriately to ensure people's well-being.

Is the service responsive to people's needs?

Staff confirmed they had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We saw that people were able to access most areas of the home, including the garden.

We observed that staff responded promptly to people's needs and that call bells were close at hand for those people that spent time in bed or their bedrooms. People were supported as necessary in a considerate manner, for example during mealtimes.

There was sufficient staff on duty at the time of our inspection, although we discussed with the provider and the manager the deployment of these staff, particularly over lunchtime which was a busy period of the day.

Is the service well-led?

The service had a registered manager. Staff told us the manager was approachable and supportive.

Documentation confirmed that the manager supported the staff to learn from incidents.

We saw that the provider had effective systems to assess and monitor the quality of the service they provided and took account of these to improve the service.

We saw that the new provider has already made improvements to the premises and we were told there were plans to do much more. For example, some bedrooms had been completely re-decorated and had new carpets fitted. One person said, 'My room has just been painted. It has really cheered me up. I am delighted.' We also saw that the central courtyard had been made attractive with flowering plants and outdoor furniture.

We found that people's privacy, dignity and independence was respected and that people were involved as much as possible in decisions about their care. We found that people's needs had been assessed and care plans to meet their needs were in place and were being used effectively by the care workers.

We found that 'Broomfield' was appropriately managed and that the staff were friendly, caring, and provided a safe and effective service that met people's needs.