Broadgate Care Home

We found the following examples of good practice.

Comprehensive checks were in place for all visitors upon arrival at reception to reduce the risk of transmission. Relatives and friends received clear communication from the Registered Manager regarding processes for visiting which were in line with current guidance. Alternative arrangements were in place as at the time of the inspection the home had an active COVID-19 outbreak.

People had been supported to go out into the community safely. For people who were unable to maintain social distancing or isolation risk assessments were completed and mitigation measures were adopted to reduce the risk of infection and transmission. Contingency plans were in place for cohorting and zoning if required.

The provider had processes in place to admit people safely from other services or from the community. The Registered Manager had kept up to date on the changes to admission guidance to ensure they were following best practice.

There were specific areas throughout the home for staff to don, doff and dispose of their PPE safely. Staff were observed to be following current guidance on the level of PPE to be wearing.

The Registered Manager had an organised system for ensuring all staff and people accessed regular testing and for tracking relevant dates following a positive test result.

Staff well being had been supported, the Registered manager had repurposed a lounge are to allow staff a larger area in which to have their breaks.

Infection risks had been thoroughly assessed and managed well. People were supported to access vaccinations. The Registered Manager was assured all staff met the COVID-19 vaccination requirements and had a tracker in place to evidence they had.

The home had made a number of changes since the last audit to improve infection control within the home and have a comprehensive contingency plan in place.

People’s experience of using this service: At our last inspection Broadgate Care Home was rated requires improvement and we found one breach of regulation relating to good governance. At this inspection we found improvements had been made and the service was no longer in breach of regulations.

The registered manager was open and honest, but concerns were identified about clinical leadership and oversight of the service. The service had identified it needed to improve and had a development plan in place for this.

Insufficient staff were deployed within the service during the night to meet the needs of people using the service. We have made a recommendation about this.

People received their medicines when prescribed and these were stored safely.

People's needs were assessed but not all care plans had been completed with measurable outcomes for people in relation to for example; effective weight or fluid management, we have made a recommendation about this.

People were supported by well trained, kind and caring staff. People and relatives all told us the staff were compassionate and knew them well.

People enjoyed the food, were given choice, and regularly offered drinks.

People were supported to move safely and staff enabled people living with a disability or dementia to navigate their environment with discreet support.

Everyone felt they or their relative were safe and that the home was meeting their needs.

People were supported by staff who knew how to identify and report any safeguarding concerns.

People were supported to have choice and control in their lives. Staff asked people for consent and the service was acting within the principles of the Mental Capacity Act.

Rating at last inspection: The service was previously inspected on 03/04/2018, (Report published 19/06/2018) and was rated as Requires Improvement.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will monitor the service on an ongoing basis and re-inspect according to our schedule. We may inspect sooner if we receive information of concern.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Broadgate Care Home is a ‘care home with nursing’. 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.

Broadgate Care Home accommodates up to 40 people in one adapted building. At the time of our inspection 32 people lived at Broadgate Care Home.

At our last comprehensive inspection in October 2015 we rated the service as 'Good.'

At this inspection we found a piece of equipment, which should have been decommissioned due to signs of damage, had been used to help people mobilise.

We have made a recommendation regarding the management of risk.

People did not always have use of their own continence products as staff believed they had none available; this meant there was a potential risk to their skin care.

Required pre-employments checks had not always been recorded as being completed. Checks that nurses’ registration with the Nursing and Midwifery Council had been renewed had not been undertaken at the time they were due for renewal.

Although activities were provided and people had been asked about how they enjoyed spending their time, we could not see this had led to satisfying and meaningful activities and interests for all people to partake in.

Systems to assess and monitor the quality and safety of services and reduce risks were not always effective.

The service is required to 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. At the time of our inspection there was a registered manager in post and they were present at the inspection.

People and relatives felt the registered manager was approachable. However some staff reported the registered manager did not listen to them and that he was difficult to talk with.

Surveys of people’s and their relatives' views had been completed, however it was not always clear what actions had been taken in response to this feedback.

Staff were supported with training to provide care in line with the service’s aims. However some people experienced poor outcomes as they were unsatisfied with the support provided to pursue activities of interest to them.

Most, but not all people, received care in a timely manner. The number of staff required to provide care for people had been calculated based on people’s needs. However, staff had not always been deployed in a way that meant people always received timely care.

People told us they felt safe and staff had been trained and showed an understanding about how people could be at risk from harm and abuse; staff were able to tell us how they would raise their concerns if this was the case.

People had care plans and risk assessments in place. Risks to people associated with their healthcare conditions were assessed and actions identified to reduce any identified risks. Other risks associated with medicines and infection prevention and control were also assessed. Medicines were managed, administered and stored safely. People could have their medicines when they needed them and records were kept of any medicines administration. Actions were taken to reduce risks from infection.

People’s care needs were assessed and were in line with current legislation, including the MCA. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s care involved other healthcare professionals when needed. Staff had been trained to meet people’s care needs and staff provided care with people’s consent. People received a balanced diet and their food and drink preferences were catered for.

The premises used were suitable for people and had been adapted when needed so people’s care needs could be met.

Staff were caring and considerate to people; staff understood it was important for people to feel listened to and spend some quality time talking with staff. Staff showed respect towards people by promoting their dignity and independence. Relatives were involved in people’s care when appropriate and records showed people and their relatives’ views were reflected in care plans.

A system was in place to monitor and respond to compliments, concerns and complaints. Systems were in place to help any learning from when things went wrong.

People experienced a flexible and responsive approach to their care needs. Staff had been trained to provide care and support when people were at the end of their lives.

Information was available in different formats and people’s communication needs were assessed.

At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the full copy of this report.

During the inspection we spoke with four people who used the service. We also spoke with six staff, including the acting manager. We did a tour of most of the premises. We also looked at some of the records held in the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We spoke with four people who used the service. Three people told us they felt the care home was kept clean. The fourth person did not provide any feedback that related to this outcome.

Staff told us they felt the care home was kept clean. Several staff told us improvements had taken place since we inspected the care home in May 2014. One staff member told us it was not 100%, but said, 'It's getting better.'

We did a tour of most of the premises. We did not notice any unpleasant odours. We looked at 12 of the bedrooms. We saw bedrooms were clean.

We looked at communal lounges and saw these were clean. However, the provider may find it useful to note we saw a chair in the corner of one lounge that was marked with what looked like food stains. We found that the chair had not been moved from the room when the staining occurred the evening before. This meant there was a risk that people who used the service would use a chair that was not clean. We saw later during our visit that the chair had been taken away and cleaned.

We looked at bathrooms and toilets. We saw these were clean.

The acting manager told us most staff had received infection control training since our inspection in May 2014 and training for other staff was planned for October 2014.

During the inspection we gathered information to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People using the service told us they felt safe. We saw that the service had a safeguarding policy. Staff told us they would report any safeguarding concerns.

However, we found concerns regarding the planning and delivery of care. For example, we saw that the eating and drinking care plan for one person did not contain sufficient detail regarding the assistance they required. We also saw that a staff member did not use an appropriate moving and handling technique when assisting a person to get up from their chair.

We found that records were not always accurate and fit for purpose. We found gaps in the Medication Administration Record (MAR) charts. We found that some fluid charts were also poorly completed. Records were not kept securely.

Two people using the service told us they felt the building was kept clean. However, we found that people were not cared for in a clean, hygienic environment.

Two people using the service told us they felt there were enough staff to meet their needs. However, another person and relatives told us they felt there were not enough staff. One relative said, 'Sometimes they've been very short staffed. Another relative said, 'Need more staff, more time for people.' We found there were not enough staff to meet people's needs.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw a DoLS policy was in place. The manager also understood their responsibilities regarding DoLS. However, two staff we spoke with did not have an understanding of DoLS.

Is the service effective?

Two people using the service told us they received the care that met their needs. One of these people said, 'They look after me to be honest.' However, another person told us they could not always reach the buzzer in their room to seek staff support.

One relative said staff provided a, 'Good quality of care.' Another relative said, 'Yes and no' when we asked them whether they felt their family member received the care they needed. The third relative told us they felt their family member was not checked enough by staff and they needed more support regarding access to drinks.

Some staff had a good understanding of people's care and support needs. However, a staff member was unable to provide enough information about a person we asked them about. We saw staff had not always acted in accordance with people's identified needs regarding pressure area care.

A Mental Capacity Act (MCA) 2005 policy was in place. We saw some completed MCA assessments. Staff told us they had received MCA training. However, one staff member was unable to explain the MCA to us.

Is the service caring?

We received mixed feedback from people using the service. Two people told us they felt staff were caring. The third person was very positive about some staff regarding this, but also said, 'Some [staff] are better than others.'

We observed the care in the downstairs lounge for 40 minutes. We only saw a small number of positive interactions between staff and people using the service during this time. We saw examples of staff using inappropriate language that did not respect the dignity of people using the service. We did observe some positive interactions between staff and people using the service at some other times during our visits.

Is the service responsive?

We heard a person call out for assistance from their bedroom. No staff were present in the area. We had to press the call bell button on the wall to seek staff assistance. We saw that the person's call bell lead had not been plugged in, which meant they had been unable to seek support from staff. We saw that some other people using the service were unable to use a call bell, which meant they required frequent checks by staff. However, we saw for five people that these checks had not always taken place at the required frequency.

We saw that a dietician had been involved regarding a person using the service. This meant specialist input had been obtained. However, we saw that the dietician had suggested in April 2014 that a medical review might be helpful, but a review had not taken place.

Is the service well-led?

We received mixed feedback from staff. One staff member told us they felt the service was well run. However, another staff member told us they felt it was not well run. The third staff member said, 'It's starting to improve a lot now' when we asked them for their views on this.

We found that effective systems were not in place to regularly assess and monitor the quality of the service and to manage risks relating to the health, welfare and safety of people using the service.

We found that improvements had been made in relation to people's consent to their care and treatment since our previous inspection. However; the provider had not fully completed the improvements about which they had informed us and improvements had not been made in line with the provider's own timescales.

We saw that people's individual needs and risks had been assessed including their pressure care, nutrition and risk of falls care needs. We found that identified needs and risks had been reviewed regularly since our last inspection.

One person who used the service told us, 'I've been in a few other care homes and the care I've received here has been the best.'

There were effective systems in place to reduce the risk and spread of infection.

During our inspection we toured the service and found that rooms were well maintained, including people's bedrooms and communal areas.

Records were kept securely and could be located promptly when needed. We found that people's care plans were stored and secured appropriately.

We saw people did not have appropriate Mental Capacity Act (2005) assessments completed for various decisions which had been taken about their care.

We saw that some care plans had not been updated with the most current information.

We spoke with relatives of people using the service who said, 'My relative feels safe and content.' Staff told us they would be happy to refer safeguarding concerns.

During our tour of the premises we observed that the environment was dusty and areas of the service were affected by building works on the premises. People's bedrooms and their access to bathrooms were not segregated from the building works.

We noted there was minimal control of people accessing the building, including workmen during our inspection.

We looked at staff rotas which showed that staffing levels had been in line with the staff numbers identified for people currently living in the home.

We saw staff had attended training, including safeguarding and infection control.

We looked at the complaints register and saw that complaints received had been dealt with appropriately and in a timely manner.

Records were not kept securely.