Broomfield Lodge

Broomfield Lodge is a residential care home providing personal and nursing care to 18 older people who may be living with dementia at the time of the inspection. The service can support up to 21 people in one large adapted building.

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

People and relatives told us they felt the service was safe. Potential risks to people’s health and welfare including Covid-19 had been assessed and there was guidance in place for staff to mitigate the risks.

Medicines were managed safely; people received their medicines as prescribed. People told us there were enough staff to meet their needs. We observed staff supporting people to remain safe and call bells were answered quickly. Staff had been recruited safely.

Checks and audits had been completed to check the quality of the service; action was taken when shortfalls were identified. People, relatives and staff were asked their opinion of the service. People and relatives were confident to raise any concerns with the registered manager and they were kept informed of any changes.

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 had been involved in developing their care plans and making decisions.

The provider followed all government guidance during the Covid-19 pandemic, and we were assured infection control risks were managed. People were supported to receive visitors in a safe way and regular Covid-19 tests were completed.

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 27 January 2020) and there was one breach 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 carried out an unannounced comprehensive inspection of this service on 20 December 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they 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 Safe and Well-led which contain those requirements.

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.

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 has changed from Requires Improvement 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 Broomfield Lodge 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.

Broomfield Lodge is a residential care home providing personal care to 20 older people who may be living with dementia, at the time of the inspection. The service can support up to 21 people in one large adapted building.

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

People told us they felt safe living at the service. However, medicines were not always managed safely, people had not always received their medicines as prescribed.

Checks and audits had been completed on all aspects of the service and action had been taken when shortfalls had been identified. However, the weekly medicines audits had not identified the shortfalls found at this inspection.

Potential risks to people’s health, welfare and safety had been assessed. There was guidance in place for staff to mitigate the risks. Accidents and incidents had been recorded, analysed and action taken to reduce the risk of them happening again.

Staff had been recruited safely and there were enough staff to meet people’s needs. Staff received appropriate training for their role and to support people effectively. People’s health was monitored, and staff referred people to healthcare professionals when people’s needs changed. Staff followed the guidance given to keep people as healthy as possible.

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 encouraged to eat a balanced diet. People had access to activities they enjoyed and were supported to be as active as possible. People were treated with kindness and compassion, people’s privacy and dignity was respected.

Each person had a care plan. People had been involved, where possible, in developing their care plans. The care plans contained details people’s choices and preferences and people told us they were supported in the way they preferred. People met with the management team before they moved into the service. People were given information in a way they could understand. People and relatives told us they knew how to complain, and issues had been dealt with quickly.

The management team attended local forums to keep up to date with developments in adult social care.

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 30 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines management at this inspection. 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.

Broomfield Lodge provides accommodation and personal care for up to 24 older people and people living with dementia. The service is a large converted property and accommodation is arranged over two floors. A lift is available to assist people to get to the upper floor. The service has 21 bedrooms, seven of the bedrooms have ensuite toilets. There were 20 people living at the service at the time of our inspection.

There was a registered manager working at the service. 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.

We last inspected the service in April 2016. We found shortfalls in the service. The provider had failed to store medicines safely, had not accurately recorded the application of creams and had not checked staff competency regularly to assess that medicines were administered safely. The provider had failed to develop a care plan for each person, which included ways in which the person preferred their care to be provided and how they could maintain their independence.

We asked the provider to provide an action plan to explain how they are going to make improvements to the service. At this inspection we found that improvements had been made.

Each person had a care plan that had been written with the person and their relative, giving details of how they like to be supported with their care. There was detailed guidance for staff to follow to provide consistent and safe care, staff were knowledgeable about people’s preferences and described how they supported people following the guidance in the care plans.

People’s medicines and creams were stored safely. There were accurate records of where and when the creams had been applied. Medicines were stored at the recommended temperature to ensure the medicines remained effective. People received their medicines when they needed them from staff trained and competent in the safe administration of medicines.

People told us they felt safe living at the service. Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. Some risk assessments were not detailed enough to ensure that all staff were providing support in a safe and consistent way. Staff told us how they provided support to people and this was safe and consistent. During the inspection the registered manager completed new detailed risk assessments. We have made a recommendation that risk assessments should include more detail.

Staff completed checks on the environment, to ensure people were safe. Accidents and incidents were recorded and analysed to identify any patterns or trends to mitigate the risk of them happening again.

Staff knew about abuse and knew what to do if they suspected any incident of abuse. Staff were aware of the whistleblowing policy and the ability to take concerns to agencies outside of the service. Staff were confident that any concerns they raised would be investigated to ensure people were kept safe.

People received effective care from staff who had the knowledge and skills to carry out their roles. Staff were knowledgeable and were able to tell us and we observed how they put their training into practice. Staff understood their roles and responsibilities, the management team worked with staff to ensure they were competent in their roles. Staff told us they felt the management team was approachable and supportive.

The registered manager followed the provider’s recruitment policy to make sure that staff were of good character. Staff completed regular training, had one to one meetings and annual appraisals to discuss their personal development.

There were consistent numbers of staff employed to meet people’s needs. At the last inspection, people told us that they were not able to always get up when they wanted to and had been an area for improvement. At this inspection, the registered manager had altered the shifts staff worked so there was an extra member of staff early in the morning to support people who wanted to get up early.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. Staff knew the importance of giving people choices and gaining their consent.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications for DoLS had been made in line with guidance.

People enjoyed a choice of healthy, home cooked meals. People told us they enjoyed the meals and they had enough to eat and drink. People’s health was assessed and monitored and staff took prompt action when they noticed any changes or decline in health. Staff worked closely with health professionals and followed the guidance given to them to ensure people received safe and effective care.

People told us that they were treated with kindness and compassion. Their privacy and dignity were respected. Staff knew people well and spoke with them in a kind and patient way. People were encouraged to express their views and opinions and these were respected by staff.

People knew how to complain and told us that they have no complaints about the service. The provider had a complaints policy and procedure.

People’s family and friends could visit when they wanted and there were no restrictions on the time of day. People were encouraged to be as independent as possible. There was a choice of activities for people to join in if they wished, some people preferred to follow individual hobbies and this was respected.

The registered manager and staff had a clear vision for the service. The registered manager had an ‘open door’ policy; people and relatives told us the management team were approachable and supportive.

People and staff felt the service was well-led. There was effective regular auditing and monitoring, any shortfalls were addressed and resolved quickly. People, relatives and health professionals were asked for their views on the quality of the service provided.

The provider had submitted notifications to CQC in a timely manner and in line with CQC guidelines.

Broomfield Lodge provides accommodation and personal care for up to 24 older people and people living with dementia. The service is a large converted property and accommodation is arranged over two floors. A lift is available to assist people to get to the upper floor. The service has 21 bedrooms, six of these bedrooms have ensuite toilets. There were 17 people living at the service at the time of our inspection.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff did not always provide people’s care in the way they preferred. Assessments of people’s needs were not always fully completed and reviews had not identified that the information was not correct. Accurate guidance had not been consistently provided to staff about how to support people in the way they preferred.

Action was taken to identify changes in people’s health, including regular health checks. People were supported to make decisions and choices.

People’s medicines and creams were not always stored safely. There was a risk that medicines would not be effective and creams would be used by people they were not prescribed to. Records were not kept when people received their cream. Checks had not been completed to make sure people had received their prescribed creams when they needed them.

People’s ability to make certain decisions had been assessed. When people could not make a particular decision, staff made decisions in people’s best interests with people who knew them well. The requirements of the Mental Capacity Act 2005 (MCA) had been met.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). Risk to be people had been identified and arrangements were in place to apply to the supervisory body for a DoLS authorisation when necessary.

People were offered a variety of activities that they enjoyed. Possible risks to people had been identified and were managed to keep them as safe as possible, without restricting them.

People told us they liked the food at the service. They were offered a balanced diet that met their individual needs. A range of foods and drinks were on offer to people throughout the day and night to make sure they were hydrated and not hungry at any time.

People were treated with dignity and respect at all times. People and their relatives told us staff were kind and caring. Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager or the local authority safeguarding team. When concerns were raised action had been taken promptly to keep people as safe as possible. Plans were in place to keep people safe in an emergency.

People and their representatives were confident to raise concerns and complaints they had about the service. People were satisfied with the response they received. Systems were in operation to regularly assess the quality of the service. People and their relatives were asked for their feedback about the quality of the service they received.

The registered manager provided leadership to the staff and had oversight of the service. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs. They were motivated and felt supported. Staff told us the registered manager and provider were approachable. Staff were supported to provide good quality care and support. They had completed the training they needed to provide safe and effective care to people. Some staff held recognised qualifications in care.

There were not always enough staff to meet people’s needs at the time they preferred. People’s needs had been considered when deciding how many staff were required on each shift. An extra staff member was not always working early in the morning to assist people to get up when they wanted. This is an area for improvement.

Checks were completed to make sure staff were honest, trustworthy and reliable. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

We found breaches 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 this report.

Care records showed that people had been supported to make decisions about their care. We saw that people's representatives had been involved in planning care and support. When people's needs changed, we found that records had been updated to reflect this. We saw that people's needs had been thoroughly assessed and care was provided taking into account people's rights and well-being.

Staff demonstrated a good understanding of how to safeguard people from harm. Training records showed that staff received regular training to update their knowledge on safeguarding and topics relevant to their care role such as dementia awareness.

Medication was correctly stored and administered within guidelines. The clinical room was appropriately organised, and policies were in place to ensure that correct medication administration and disposal was adhered to.

Staff reported feeling fully supported by management and were positive about colleagues.

People told us that they had the care and support they needed to remain well and healthy. People said they liked living at the service. We found that where possible people were asked to give consent and were involved in the decisions about the care and support they received. Where this was not possible we found that best interest meetings and mental capacity assessments had taken place.

We found records to show how people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well being.

People told us and records confirmed that medicines were given to people when they needed them in a safe way.

People and their relatives told us that they thought that there were enough staff on duty and they knew what they were doing. Staff listened to people's requests and responded quickly. People said, 'The staff are very helpful and reassuring' and 'All the staff are very kind and patient'.

People and their relatives told us they did not have any complaints about the service. They were confident if they did the manager would take action to resolve any issues.