Archived: Broadlands Residential Care Home

At the previous inspection on 4 September 2014 we asked the provider to take action to make improvements to the areas of maintenance to the building, people’s care records and systems to regularly assess and monitor the quality of the service people received. At this inspection we found that improvements had been made in these areas.

We found the carpets had been replaced, two bedrooms had been completely redecorated, other bedrooms had been painted and there was new furniture in the lounge. An annual development and maintenance plan was in place for the next year so further improvements could be made.

Systems to regularly assess and monitor the quality of the service were in place. Satisfaction surveys had been completed by people who used the service and relatives and requests acted upon. Resident, relative and staff meetings had taken place.

The service had a registered manager in place at the time of our inspection. 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.

People told us they felt safe. Staff had attended safeguarding adults training, could identify different types of harm and knew the procedure for reporting concerns. Relatives said that their relations were safe. People were supported by an appropriate number of staff and they were recruited through safe recruitment practices. People received care promptly when requesting assistance.

People’s medicines were not always managed safely. People were not always given information about the medicines that they were taking.

Members of staff were given an induction to prepare them for the role and they received regular support and supervision to help them carry out their role.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. People’s care records showed that mental capacity assessments were in place for a variety of decisions and applications had been completed appropriately for people and under the Deprivation of Liberty Safeguards (DoLS).

Not all staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards . This put people at risk of not receiving care and support that is in their best interest.

People were provided with a varied, balanced diet with a variety of choices available. People’s day to day health needs were met by the staff and external professionals.

People and their relatives told us that the staff were very caring. People were supported to contribute to decisions relating to their care. People who used the service were at ease with members of staff and they both spoke openly and warmly to each other. Information was available for people about how to access and receive support from an independent advocate. People’s privacy and dignity was respected.

Activities were offered but these were limited. People were involved in their care and their care records were written in a person-centred way that took into account people’s strengths and support needs .Care plans were reviewed regularly and changes recorded. The complaints policy was accessible for everyone and people knew how to make a complaint.

The management team were visible and approachable with staff and people who used the service. They encouraged open communication with people who used the service, relatives, visitors and staff. Staff told us that they would be confident to raise any issues, concerns or suggestions. There were systems in place to monitor and improve the quality of the service provided.

We last inspected this service on 6 November 2013. At that time we found that people using the service, staff and visitors might be at risk because the environment was not safely maintained. We also found that gaps in staff training meant there was a risk that care staff were not appropriately trained to enable them to deliver care and treatment to people safely. We found care plans did not always contain appropriate guidance to ensure people's welfare and safety were fully protected. There was also a risk that people were not protected against unsafe or inappropriate care due to inconsistent record keeping.

At this inspection we found that gaps in the training and supervision for care staff had been addressed. We found the service had made improvements to the environment but further improvements were still needed. We found people were not cared for in surroundings that supported their health and wellbeing. We found people were not protected against the risks of unsafe or inappropriate care because records in respect of each person's care were not accurate. At this inspection we found that the provider did not have an effective system for assessing and monitoring the quality of the service. We used the evidence we collected during our inspection to answer five questions. A summary of what we found is set out below.

Is the service safe?

We spoke with three care staff who understood the systems in place to protect people from abuse or neglect. They told us they received training in how to protect people. We found examples of the service acting to safeguard people, for example, when one person had complained about another person's behaviour.

We saw personal evacuation plans were in place for each person. These identified the level of support the person needed to evacuate the building in an emergency, for example a fire.

There were no Deprivation of Liberty Safeguards (DoLS) in place at the time of our inspection. The Deprivation of Liberty Safeguards are a legal framework designed to ensure that the care people receive does not unlawfully deprive someone of their liberty. The manager and care staff we spoke with understood the process of assessing a person's mental capacity and we saw documented examples of decisions made in a person's best interests.

The service had policies in place for managing medicines safely and for identifying and acting on medicines errors.

At our last inspection we found care records for each service user were not accurate. At this inspection we found records contained information which had been changed by hand which was confusing and gaps in some clinical information which meant people were not protected from the risk of unsafe care.

Is the service effective?

Care staff we spoke with understood people's needs. People's needs had been assessed and we saw support plans had been reviewed and updated.

The service had arrangements in place to access support from the local GP practice. The GP visited the home every week. The manager contacted the GP surgery beforehand to make them aware of any health issues which had cropped up during the week.

The service had implemented the Gold Standards Framework (GSF) for developing best practice around end of life care. The service was also using professional guidance for improving the quality of care provided for people with dementia. Care staff had the appropriate training and experience to enable them to carry out their role effectively. Care staff told us they felt supported and received regular supervision and appraisal.

Is the service caring?

A relative we spoke with told us, 'People are treated as individuals. It's the quality of care that's important.' They said their relative was always neat and tidy and well dressed. They told us they felt welcomed by the staff which helped them be involved in their relative's care. They said they visited often and care staff were always very respectful towards the people who used the service. They told us care staff were always very patient with people.

We spoke with someone who used the service who told us they found staff were very caring. They said, 'Sometimes people are upset and staff are really patient and reassure them.

We observed care staff support someone who was upset and saw them comfort and reassure them. We observed care staff providing support and that they had a good rapport with people. Care staff we spoke with told us knew people well and responded to people's needs.

Is the service responsive?

On the day of our inspection one person's circumstances had unexpectedly changed. The person had been using the service for respite support but now needed longer term care. We observed the manager liaise with the local authority social services department to make the necessary arrangements and support the person who had been expecting to return home.

We saw from records that the manager had obtained comments about the menus from a survey of people's views. We spoke to the manager and cook about the comments and how the service had responded to them. The manager and cook told us about the changes to the menu in response to the views expressed by people who used the service.

Is the service well-led?

The service had surveyed the views of people who used the service and had developed a programme of improvements based on the results. This had led to changes in the menu and improvements to the home environment. The manager had developed a list of actions the service was taking in response to issues raised in a review undertaken by the local authority. We saw these were in the process of being addressed.

The service had introduced a system for ensuring people received a high quality service at the end of life. The provider was changing the approach to caring for people from task orientated care towards care with a greater emphasis on a person's feelings and emotions.

The manager told us the provider was supportive and involved in the running of the service. A relative told us the provider was visible in the home and approachable if they had any questions or concerns.

Whilst the manager had obtained the views of people who used the service in the previous year it was not clear how the service had continued to involve people and demonstrate progress with the issues identified. We did not see a system which drew actions together or monitored how improvements were being made.

We observed that staff interacted with people who used the service in a positive and supportive manner. We spoke with two people who used the service regarding the food. One person said, 'I'm very satisfied with the food.'

We found mixed evidence about how the provider was ensuring people were cared for in safe and suitable premises. We found areas of the home which required maintenance to ensure the on-going safety and suitability of the premises.

We spoke with one person using the service who said, 'I think the staff are well trained.' However, gaps in staff training meant the provider could not be reassured that all staff were suitably trained.

We found that there was a process in place to receive, investigate and respond to any concerns raised about the service. We saw that care records and staff files were kept in an unlocked filing cabinet in the manager's office, but that staff could locate records promptly when needed.

We found people gave consent to their care and treatment and received care and support that met their needs. A person told us, 'I have had a talk about my care plan.'

We found people were safeguarded from abuse and there were suitable arrangements for the management of medicines. A person told us, 'Having people around makes me feel safe.'

We found the premises were safe and suitable and repairs needed were planned to take place. A person told us, 'It is always nice and warm in here.'

We found the provider had an effective recruitment procedure in place and ensured there were suitably trained staff available. One person told us, 'I am satisfied with the staff, they are very caring.'

The provider told us they were taking steps to ensure there were sufficient staff on duty. One person told us, 'It is definitely better when there are three staff on duty.'

We found the provider assessed and monitored the quality of the service. A person who used the service told us, 'We have residents' meetings.'