Broadacres Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found breaches of legal regulations in relation to medicines management and how risks associated with people’s care were assessed. These were breaches of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks associated with people’s care had not always been identified and documentation in place to guide staff was not always up to date and clear. Systems in place to manage medicines were not always effective. People told us they felt safe living at Broadacres. The provider had systems and processes in place to ensure people were safeguarded from the risk of abuse. The provider evidenced lessons they had learned when things had gone wrong and they used these to improve the service.Staff were recruited safely and there were sufficient staff available to meet people’s needs, however, staff needed guidance to ensure they were deployed effectively.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe living at the home and said staff treated them well. One person said, “I feel safe. I have no concerns.” A relative said, “We have no problems with safety, we would have moved [relative] if we had.”

The service supported student placements from a local college. Students told us they felt supported by the staff team. There was limited feedback from staff at Broadacres about the learning culture of the service.

Accidents and incidents were recorded and showed trends and patterns had been identified. However, there was a lack of evidence to show what actions had been taken to mitigate future risks. Care plans and risk assessments did not always identify people’s current needs.

People told us the staff arranged healthcare professionals if needed. One person said, “The district nurse visits me twice a day.” Another person said, “It’s this place that’s put me back on my feet.” One person told us how the doctor had been called when they were not feeling well. They said, “I’m waiting for the doctor to visit today.”

Staff demonstrated they knew people but there was a lack of knowledge and understanding about peoples care needs, assessments and reviews in their care plans.

Concerns about the quality of care and support provided at the service had been raised by local partners and colleagues. A quality assessment had been completed by the Local Authority contracts team. The outcomes of the quality assessment highlighted a range of concerns and areas for improvement that included, for example, care plans, risk assessments, diabetes management and personal evacuation plans.

During our inspection we saw district nurses and social workers visiting the home. Reviews of people's needs and 'Decision Support Tools' took place on the day of the site visit. We also saw that the district nurse had been asked for their advice and support in relation to a medicines error. People's care and plans and assessments were not always completed and reviewed in a timely manner. There was an electronic care planning system in place that enabled a hospital information pack to be printed off and shared with health and care professionals if required when transitioning to a different service.

People told us they felt safe living at the home and said staff treated them well. One person said, “I feel safe. I have no concerns.” A relative said, “We have no problems with safety, we would have moved [relative] if we had.”

Staff were able to demonstrate knowledge of safeguarding processes and how to keep people safe from abuse and harm.

On the day of inspection there were no unsafe practices observed. Moving and handling of people was carried out safely and correctly. People were treated with dignity and respect and kept safe from harm and abuse.

The service had a safeguarding log in place and a medication error that occurred on the day of inspection had been reported to the local safeguarding adults team and a notification submitted to CQC. There was a Deprivation of Liberty Safeguards (DoLS) tracker in place that kept a log of when DoLS applications had been applied for and approved. Mental Capacity Act (MCA) assessments and Best Interest meetings to record key decisions were not completed consistently and they were not always personalised to each individual.

People told us they felt safe living at the home and said staff treated them well. One person said, “I feel safe. I have no concerns.” A relative said, “We have no problems with safety, we would have moved [relative] if we had.”

Staff told us they include people and their families in their care and support. They informed us that risk assessments and care plans were updated monthly but if there were any changes then they would be updated sooner. This was not always evidenced in people's care plans, risk assessments and reviews.

We did not observe people being involved and included in assessments and reviews to help identify and review their risks and assessed needs.

Risks associated with people’s care had not always been identified. Documentation in place to guide staff was not always up to date and clear. Some people required the use of a hoist to transfer but loop configuration and size and type of sling to use were not constant with slings being used. Slings were not always labeled and there was a danger of slings being wrongly used. Slings which were labeled were found in the wrong bedroom. Some people who were at risk of pressure damage did not have clear instructions in their care plan. For example, one person’s care plan stated 2 people were required to support repositions but did not state how often they should take place.

One relative said, “There is always a sling available when our relative wants to transfer from bed to chair or wheelchair. They [Broadacres] had recently purchased a new one for her as the old one had become stained.”

We asked how often the water outlets were flushed and checked. The provider informed us that all water outlets including unused rooms were flushed monthly and information recorded.

We carried out a tour of the home and found the home was in need of some work. The home was dull and uninteresting and not dementia friendly. Two toilets on the upstairs unit had been closed off and actually screwed shut because they were out of order. Staff told us they had been out of order for several weeks.

Appropriate quality and safety checks on equipment including bath lifts, hoists and fire extinguishers had been completed within the prescribed timeframes. Water temperature checks and flushing records were maintained by the service.

We received mixed feedback regarding the number of staff available to meet people’s needs. Some people and relatives told us there sometimes were not enough staff. However, other people and relatives felt there were sufficient staff available to meet people’s needs. One relative said, “There always seems to be enough staff to get drinks and sort things for people.”

Staff told us that sometimes they feel they are rushed off their feet but they do get around to see to everyone and meet their needs as identified in their care plans. We heard that high usage of agency staffing in the care home impacts on the care people received and reduces teamwork. Staff work across both upstairs and downstairs units in the care home so they get to know everyone but there was a feeling that there would be more improved consistency if staff worked on same unit.

There was little staff interaction and engagement with people in lounges but staff were observed supporting people in their rooms and providing drinks and snacks. Staff supported people during mealtimes but it was a transactional experience. There was little or no conversation and no explanations of meals or choices.

Staff were recruited safely and the pre-employment checks were carried out. Staff files were well organised and contained appropriate paperwork including evidence of training courses accessed and supervision notes.

People were clean and well kempt. There were no complaints about the cleanliness of the home and the environment. Although people responded positively and did not raise any concerns in respect of infection prevention and control we were not assured they were fully protected because our observation of the care environment identified that it was below the standards expected.

Staff did not provide any feedback about infection prevention and control and cleanliness of the care home.

We carried out a tour of the home with the manager as part of the on-site inspection and we found the upstairs kitchenette was in need of a deep clean. The microwave was rusty on the inside and sealant around worktops and sinks was marked and not clean. The provider took action to address the issues identified. Store rooms were untidy and needed cleaning. In 2 of the store rooms there was carpeted flooring which was old and beyond cleaning. The laundry had some flooring coming up behind the dryers which was caused a gap where dust and debris had collected. Aprons were on store room floors and left hung on coat hangers in open areas. One of the store rooms had toiletries stored in it and some were labelled some were not. There were some razors and hair brushes in the cupboard that had been used but were not named. This showed that care and support was not personalised to each individual.

There were a team of domestic staff who cleaned the home methodically to ensure that general high traffic areas were clean. Our observations of the environment did not provide assurance that systems, processes, checks and audits were effective in identifying shortfalls in the cleanliness of the home in areas where food and drinks were prepared for people.

People told us they received their medicines as prescribed. One person had received a double dose of their morning medication as a result of poor record keeping and communication. The staff had taken appropriate action and received clinical guidance and information from NHS 111 whilst maintaining close observations of the person involved.

Staff told us they had received medication competency training and training to use the electronic medicines recording keeping software but they could have done with more training. Some members of staff told us they did not feel comfortable with the electronic medicines recording keeping software.

Medicines were not managed safely. There had been ongoing issues with booking in medications and subsequent medication stock levels did not tally. The service had identified a medicines champion who would be spending time in the service to support the implementation of an improved system to book medications in safely and properly. We reviewed protocols for medicines prescribed on an ‘as and when required’ (PRN) basis and found they did not detail how people would present if they required their medicines and were unable to communicate this. There were disparities between care plans and PRN protocols. For example, a person's care plan stated they are unable to verbalise due to their dementia, however the PRN protocol for their pain relief stated they are able to verbally inform staff if they are in experiencing any pain.