We carried out a review of the data available to us about Broughton House - Veteran Care Village on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Broughton House - Veteran Care Village, you can give feedback on this service.
Broughton House – Veteran Care Village provides nursing, residential and respite care to ex-Service men and women. Accommodation is provided over two floors within a three storey purpose built facility. The home is registered to support up to 32 people. At the time of this inspection 19 people were living at the home, albeit three were currently in hospital.
People’s experience of using this service and what we found
People felt safe living at Broughton House – Veteran Care Village. Staff had received training in safeguarding and how to identify and report concerns. Risks to people and the environment had been assessed and actions taken to minimise these risks from occurring. Accidents and incidents had been documented and reviewed, to help prevent a recurrence. Enough staff had been deployed to meet people’s needs, with staff feedback confirming this. Medicines were managed safely by trained and competent staff.
The home had an updated audit and quality monitoring schedule in place, to ensure all aspects of care, support and safety were assessed and actions taken to address any concerns. People and staff spoke positively about how the home was being run, with each one confirming they would recommend the home to others. The current manager and nominated individual were reported to be approachable, supportive and a visible presence in the home.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published January 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We received anonymous concerns in relation to risk assessments, staffing levels, management of medicines, maintenance of the premises and the overall management of the home. The home had also experienced an outbreak of COVID-19, which had affected the majority of people living there. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We found no evidence during this inspection that people were at risk of harm from these concerns.
Please see the safe and well-led sections of this full report.
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 coronavirus and other infection outbreaks effectively.
The overall rating for the service has improved to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Broughton House – veteran Care Village 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 House - Home for Ex-Service Men and Women is a nursing home providing personal care to 29 people aged 65 and over at the time of the inspection. The service is registered to support up to 35 people.
People’s experience of using this service and what we found
People told us they received their medicines as they should. However, the provider did not have
robust systems for the proper and safe management of medicines. Some systems and processes did not always assess, monitor and improve the service provided.
We looked at systems for the recruitment of staff, staff deployment and people’s care plans. We have made a recommendation about the deployment of staff and a recommendation about following good practice guidance to ensure care plans reflect people’s needs.
People's care and support had been planned in partnership with them and their relatives. Staff had received regular training and supervision to support them in their roles. 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.
People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. People told us they felt safe when supported by contracted staff. Relatives told us they felt their family members were safe at Broughton House - Home for Ex-Service Men and Women. Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care.
People received person-centred care which was responsive to their needs. People's communication needs had been assessed and where support was required these had been met. The interim manager dealt with people's concerns and complaints appropriately. One relative said, “They [staff] pre-empt things because they have a lot of experience they can see problems arising quickly and start dealing with them straight away.”
People were positive about the service and said staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld. The service could provide people with information about local advocacy services, to ensure they could access support to express their views if they needed to. The management team worked with people’s advocates.
The service worked with a variety of agencies to ensure people received all the support they needed. People were happy with the service and support that they received. Staff felt well supported by the management team.
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 10 May 2017).
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see the safe and Well-led sections of this full report.
Enforcement
We have identified breaches in relation to the management and administration of medicines and the management and oversight of the service delivered.
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 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.
Broughton House provides nursing, personal care and accommodation for a maximum of 50 ex-service men and women and is a registered charity. The home is situated in a residential area of Salford. There are car parking facilities to the front and side of the building. The home has an array of military memorabilia on display with a military museum on the first floor. There are easily accessible spacious, well-kept garden areas with a private cenotaph surrounding the building and a separate entrance that had full ramp access for wheelchair users.
At the time of this inspection there was a manager who had been in post since December 2016. The manager had submitted the relevant paperwork to progress to registered manager status with the Care Quality Commission. 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 manager was supported in her role by the home’s deputy manager.
The service was last inspected on 11 December 2015. We found the service to be in breach of three regulations applicable at that time. These were in relation to the safe management of people’s medicines, not taking reasonably practicable steps to mitigate any identified risks to the people using the service and failing to maintain accurate and complete contemporaneous records.
During this inspection, we found the service was now meeting the current regulations and was no longer in breach of the above.
People told us they considered themselves safe whilst living at Broughton house. They also indicated that the care they received was delivered in a professional and caring way and that staff had the correct skills to undertake their role effectively.
People were provided with a personalised care and support pathway which was tailored to their individual needs and requirements. The service also ensured it maintained a satisfactory staffing level to support the safe and effective operation of the service. Comments from people supported that there were enough staff to safely meet their needs and people told us they never felt rushed with their routine. The provider offered a variety of training to its staff which ensured the staff team were skilled and experienced to safely and effectively support each person using the service.
Care files contained person centred assessments and care plans to support the development of the care planning process and support the delivery of care. Effective systems were implemented to maintain independence, by providing a detailed plan covering essential information care staff needed to follow. This ensured clear information about people’s needs wishes, feelings and health conditions. These were kept under regular review. People’s consent was also sought during this process.
The service ensured practices were in place to maintain and uphold a suitable and safe environment for all people using the service and their visitors. Recognised training was offered to staff to ensure they were able to confidently identify the signs of abuse and positively respond to any safeguarding concerns by notifying relevant individuals and authorities when required.
Robust recruitment systems were applied. Appropriate steps were taken to verify new employee’s character and fitness to work. Following successful appointment to the role the provider ensured a detailed induction plan was offered. This ensured staff were equipped with the correct skills and knowledge to effectively support people in an informed, confident and self-assured manner.
Staff interacted in a positive way with people. Their demeanour was that of a caring, respectful and understanding nature. The promotion of people’s dignity and rights were supported which ensured people maintained control over their lives. People were given information about their care and the service to help them make informed decisions. Their opinions were routinely sought and acted upon by means of questionnaires enabling them to influence the service they received. Comments were received from people during the inspection which supported these observations.
Safeguards were in place to take immediate action against staff in the event of any misconduct or failure to follow company policies and procedures.
Fire audits were completed and relevant checks were carried out to fire equipment and lighting. People using the service had personal evacuation risk assessments in place and the provider had an additional contingency plan which provided direction on who to contact and how to act in the event of an emergency or failure in utility services or equipment.
Appropriate processes were in place for the safe administration of medicines in line with best practice guidance from the National Institute for Health and Care Excellence. Nurses had received training in medicines management and all medicines were stored securely and safely.
People’s dietary requirements and preferences had been sought and we saw choice was given at every mealtime. Adequate hydration stations were available and offered hot and cold drinks throughout the day along with fruit and other snacks. Referrals had been made to health professionals when appropriate and instructions were followed in cases where people had known dietary requirements.
Staff displayed an awareness of the Mental Capacity Act 2005 and had completed appropriate training. Referrals had been submitted to the local authority by the registered manager when appropriate.
All people spoken with including relatives and staff were complimentary about the management structure. People described the manager and deputy manager as helpful and professional. Staff informed us they felt well supported and that they could approach either manager with any concerns.
It was evident that both the manager and deputy manager had implemented positive change to the service which had ensured that the service was now fully compliant with the Regulations as set out by Health and Social Care Act 2008 and associated Regulations about how the service is run.
This was an unannounced inspection carried out on 11 December 2015.
Broughton House is registered with the Care Quality Commission (CQC) to provide nursing, personal care and accommodation for a maximum of 50 ex-service men and women and is a registered charity. The home is situated in a residential area of Salford. There are car parking facilities to the front and side of the building. The home has an array of military memorabilia on display with a military museum on the first floor. There are spacious, well-kept garden areas surrounding the building and a separate entrance that had full ramp access for wheelchair users.
There was 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.
When we last inspected this service in April 2014, we did not identify any concerns with the service.
During our inspection, we found three breaches of two Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3), in relation to risk assessments, medication and record keeping. You can see what action we told the provider to take at the back of the full version of this report.
We found that initial risk assessments on admission were generally complete. However, we found examples where risks were identified with no action taken to reasonably mitigate such risks. One example related to an individual who chose to spend most of their time sat on their own in the home. This individual was of a different cultural background to the majority of people living at the home. We found at least one other person who used the service had been identified as having racist opinions and had previously racially abused members of staff. Though we found risk assessments in place to protect this individual against harm, there was no mention of how the home would protect them from potential racist abuse.
In another example, we found a person who had recently been admitted to the home, had been identified as having had poor eyesight, suffered from vertigo and confusion. This person was identified as requiring the support of walking aids, but often forgot to use them and did not recognise the dangers of mobilising without them. We found that this person had been allocated a bedroom on the first floor of the home. The room was directly next to the stairwell. The nurse completing the care plan had identified that the location was not ideal, but was awaiting a room becoming free on the ground floor. There was no evidence that the risks identified had been effectively addressed or had been discussed with the person who used the service or their family.
When viewing the care plan of one person who suffered from three serious illnesses, their records failed to identify how these illnesses should be managed safely. In particular, the problem relating to one illness talked about staff observing for symptoms, however it did not explain what these were.
This is a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3), safe care and treatment, because the service had failed to demonstrate that they had taken all reasonably practicable steps to mitigate any identified risks.
As part of the inspection we checked to see how the service managed and administered medication safely. We found people were not always protected against the risks associated with medicines, because the provider did not have appropriate arrangements in place to manage medicines safely. In four records we looked at relating to the administration of prescribed creams we found repeated gaps and omissions. This meant the service could not demonstrate that the medication had been administered in line with the prescription.
We found an example when the home had run out of a prescribed medication for a person who used the service. We were told that the pharmacist had not delivered the correct amount, which meant the person did not have their medication administered for two nights. We spoke with the person who used the service who told us that sometimes there were delays in getting their medicines. They had run out of medication last Sunday and no explanation was provided by the home as to why they didn’t have enough stock.
This is a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3), safe care and treatment, because the service failed to ensure sufficient supplies and the proper and safe management of medicines.
We found that care plans did not always accurately reflect people’s current needs. The service used two sets of care files for each person who used the service. One was paper based and the other was an electronic record. We repeatedly found information in paper files, which was either out of date or missing. The potential existed for a member of care staff to act on wrong or missing information if referring to the paper files for instructions relating to an individual’s care
People and their relatives told us that the home was responsive to their needs and they were involved in deciding the care they or their loved one’s received, however this was not clearly documented in care files we looked at.
We found that for some people lacking capacity to make specific decisions for themselves there was no clear, readily accessible record of what had been done to assess this need and the outcome. We found that a facility existed on the MCA electronic file for this to be recorded, however we found that in some instances fields had not been populated. We also found examples that risk assessment and care plan review dates were either missing or out of date.
This is a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3), good governance, because the service had failed to maintain accurate and complete contemporaneous records for people who used the service.
We found people were protected against the risks of abuse, because the home had appropriate recruitment procedures in place. Appropriate checks were carried out before staff began work at the home to ensure they were fit to work with vulnerable adults.
We found the home had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse.
We looked at how the service ensured there were sufficient numbers of staff on duty to meet people’s needs and keep them safe. During our visit we found there were sufficient numbers of staff on duty during the day to support people who used the service. When we spoke with staff we received conflicting views regarding staffing levels. On the whole, nurses told us that they felt staffing levels were sufficient, whereas most care staff felt the home was often under staffed.
Staff we spoke with said they received an induction when they started working at the home, which included classroom based training and shadowing more experienced staff.
All staff we spoke with confirmed they received supervision and appraisals, which we verified by looking at supervision records and a supervision matrix.
At the time of our inspection, there were a number of people living at the home who were subject of a Deprivation of Liberty Safeguards (DoLS). The service monitored DoLS by use of a log, however we found that this record was incomplete as there were 14 names on the list with no information recorded.
Where it had been identified that people did not have capacity to make choices, then the appropriate requests for Deprivation of Liberty Standards (DoLS) were in evidence as well as best interest decisions.
Throughout our inspection, we observed staff seeking consent from people before delivering any care or treatment such as medication, support with mobilising, personal hygiene or support with eating.
We have made a recommendation about ‘dementia friendly’ environments.
The home undertook an initial assessment to identify any dietary and nutritional needs. We looked at food and fluid intakes charts, which were reviewed on a regular basis.
Staff were complimented on the way they approached and cared for people who used the service.
Throughout our inspection, where we observed interaction between staff and people who used the service, it was kind, appropriate and caring. People looked clean and well groomed. Staff knew people well and there was a friendly atmosphere between staff and people living at the home.
The home was also a member of ‘Care Aware Advocacy Service,’ which was a ‘one stop shop’ for people and families to seek independent advice and support.
During our inspection, we checked to see how people were supported with interests and social activities. We found that the home had a dedicated activities co-ordinator, who was also the Welfare Officer. People we spoke with were able to describe a comprehensive list of activities they could join in within the home, which included outings to engage in various social events.
We found that the service routinely listened to people to address any concerns or complaints.
While nurses told us they were supportive of the new manager, a number of care staff we spoke with felt there was a 'disconnect' between the registered manager and care staff who were very unhappy. We were told that the management team were rarely seen on the floor. They told us that they did not feel valued or listened to by the registered manager. Other care staff felt the registered manager was approachable and that the changes made had been on the whole positive and had contributed to improving the home.
We spoke to the registered manager about these concerns, who demonstrated a clear vision of the changes that were required. They acknowledged that there had been some unhappiness with some staff in relation to working practices and the changes implemented since their arrival and that some staff had left the service. The manager told us that they felt communication between management and staff needed to improve in order to successfully implement the changes they proposed.
We found the service undertook an extensive and comprehensive range of audits and checks to monitor the quality of services provided. However, we questioned the effectiveness of some of these audits in light of the issues we found in respect of medication, risk assessment and the quality of record keeping within care files.
Providers are required by law to notify CQC of certain events in the service such as serious injuries, deaths and deprivation of liberty safeguard applications. Records we looked at confirmed that CQC had received all the required notifications in a timely way from the service.