Archived: Broad Acres

Updated 23 June 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 3 and 4 April 2017 and was unannounced.

The inspection team consisted of an inspector, a specialist advisor and an expert-by-experience. Our advisor was a specialist in clinical governance and dementia. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our expert at this inspection had experience of caring for a person who used this type of service.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used this information to plan our inspection.

Before our inspection we reviewed information we had received about the service such as notifications. This is information about important events which the provider is required to send us by law. We also looked at information sent to us from other stakeholders, for example the local authority and members of the public.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with eleven people who used the service and five relatives. We also spoke with a visiting advocate. We observed the care and support provided to people and the interaction between staff and people throughout our inspection. The provider is also the registered manager and clinical lead for this service and they were present throughout the two days of our inspection. We also spoke with the deputy manager, two registered nurses and care staff.

To help us assess how people’s care and support needs were being met we reviewed eight people’s care records and other information, for example risk assessments and medicine administration records. We looked at four staff personnel files and records relating to the management of the service. This included recruitment, training, and systems for assessing and monitoring the quality of the service.

Updated 23 June 2017

This inspection took place on 3 and 4 April 2017 and was unannounced. At the last inspection on 2 February 2016, we asked the provider to take action to make improvements to the signage and decoration in the service, record keeping and the assessing and how they assessed and monitored the quality of the service. We received an action plan from the provider stating they would meet the relevant legal requirements by 31 May 2016. At this inspection we found that they were still in breach of some regulations. At this inspection we found that although some minor improvements had been made the service still needed to improve further and in some areas had deteriorated.

The service provided nursing care and support for up to 48 people some of whom have mental health needs and others who may be living with dementia. On the days of our inspection there were 34 people living in the service.

The service had a registered manager who was also the provider and clinical lead. 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 decoration within the service did not always support the needs of people living with dementia and in some instances was not safe. Quality assurance processes had not identified deficiencies in people’s care plans or shortfalls in the quality of the service provided.

The service did not keep up to date with national safety alerts issued by government. A serious incident had occurred, the circumstances of which had been addressed by an alert. In another case there was no evidence to confirm the service was following safe mouth care practice when an alert had been issued regarding this. People were being placed at an ongoing risk.

Staff did not receive the necessary competency checks. Nurses who had carried out training had not had their competency checked. The registered manager who was also the clinical lead was not aware of their responsibilities in this regard. Therefore people were placed at potential risk of receiving unsafe care and treatment from nurses. Safeguarding training was inadequate to meet the needs of staff as it consisted of a handout and a questions and answers sheet. The service had not introduced the Care Certificate for care staff and therefore the quality of care offered was not as it should be.

An incident which was a safeguarding concern and which was a disciplinary matter had not been recognised as such, reported to the correct authorities or investigated thoroughly. People were not effectively protected from possible harm.

People did not always have their choices and preferences met in how they lived their daily lives. These were not recorded in their care plan and staff did not demonstrate an understanding of the Mental Capacity Act when providing care and support.

Whilst some care staff were observed to provide care and support with kindness and compassion others did not. The approach to care was not consistent and there was no routine monitoring of staff practice to address this. We saw a reliance on staff who were intuitively good carers but no actions in place to support and improve others practice.

Nursing care and clinical governance was poor. The management of pressure ulcers and catheters did not reach required standards. Pressure relieving equipment was not set to the appropriate levels. People were placed at ongoing risk of developing sore skin and not receiving effective treatment for the pressure ulcers they had sustained.

People were not supported with their social needs. The only organised activities observed during the two days of our inspection was a game of skittles.

The leadership of the service was poor. The service quality assurance processes were not used to drive improvement and had not independently recognised the issues raised in this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.