Archived: Broad Acres

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.

Broad Acres provides care and accommodation, including nursing care for up to 48 older people, some of whom may be living with dementia. On the day of our inspection there were 40 people living in the service.

The service had 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.

Staff had a good understanding of what constituted abuse and told us that they would be confident to recognise and report it. Senior staff, including the registered manager, were aware of their roles in relation to reporting allegations to appropriate external agencies. Staff were recruited safely and appropriate background checks carried out.

The registered manager did not have a formal ‘tool’ to assess staffing requirements. People and some staff told us that staffing levels could be stretched particularly at busy times such as in the evening when people wanted support to go to bed.

Risks to people such as falling or acquiring a pressure ulcer were assessed and actions to mitigate the risk put in place. These risk assessments were reviewed regularly and amended where necessary.

People’s fluid intake was not always recorded and monitored effectively. Drinks were not left within easy reach of people to encourage fluid intake. The dining experience was calm and relaxed with staff promoting independence and encouraging people to eat sufficient amounts.

People were supported to access healthcare professionals such as a chiropodist and GP.

People and their relatives, where appropriate, were involved in their care planning. People’s privacy and dignity was now always respected with night staff leaving all bedroom doors open.

The decoration and signage within the premises did not meet the needs of people living in the service, particularly those living with dementia.

The service had made appropriate referrals under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, recommendations by the authorising body had not always been followed. Staff had received training in the MCA but this was not always put into practice.

Care was not always provided in accordance with people’s assessed needs, particularly in regard to those living with dementia. Staff did not always communicate with people in a way which they could fully comprehend.

Resident, relative and staff meetings were not held regularly to ensure that people could express their views and be involved in the development of the service. The manager called a meeting when there was something to discuss.

The service did not implement up to date policies and procedures. Quality assurance audits and internal quality audits were not used to drive improvement in the service.

You can see what action we told the provider to take at the back of the full version of the report.

This is a summary of what we found;

Is the service safe?

We found that the service was safe. When we arrived our identification was checked and we were asked to sign the visitor's book. This showed that the staff took the security of the building and the safety of the people who lived there seriously.

We looked around the property which we found was clean, and free from unpleasant odours. It was well maintained and was a safe environment for the people who used the service.

We saw records which showed that the health and safety checks were carried out in the service regularly and action was taken if equipment was found to be faulty or unsafe. This included regular visual checks and servicing of equipment such as hoists, the fire alarm panel and wheelchairs. Regular fire safety and legionella tests and checks were carried out, which showed that people were protected from unsafe or poorly maintained equipment.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), which was updated every year. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

The service had an effective recruitment system in place and safeguarding checks were carried out on new staff to ensure that they were suitable to work with vulnerable people.

Is the service effective?

The majority of the people who used this service were living with dementia and were unable to communicate their needs. However, the staff we observed showed a good understanding of people's needs and demonstrated that they had built up good relationships with the people they supported. This ensured that the staff knew the person they were caring for and that people were being supported in a way that would protect their health, wellbeing and independence.

We were able to speak with three people. They told us that the staff treated them well and worked hard. One person said, "I've no problems, they (the staff) look after me well.' Another person told us, 'I have no grumbles."

During our observations of the care and support given to people, we saw that the service was effective in meeting people's needs.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We saw that the service was effective in assessing people's nutritional needs and offered a good and varied menu, while ensuring that health needs and preferences were met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, respectful and professional manner. Not all the people were able to talk with us, but during the time we spent at the service we saw staff were committed to caring for the people they supported.

We spoke with three people and they told us that the staff were kind and considerate.

Is the service responsive?

We saw evidence that the service was flexible and made changes as required to ensure people were kept safe. People's care records showed that where concerns about their health and wellbeing had been identified, the staff had taken appropriate action to ensure that people were provided with the support they needed. For example, they sought support and guidance from health care professionals, including the doctor, the speech and language team and the dietician.

The people who used the service, their relatives and other professionals involved with Broad Acres were given the opportunity to complete annual satisfaction questionnaires. The manager said that the service responded to concerns raised with them. This would ensure that the quality of the service was maintained.

Is the service well led?

The service had an effective quality assurance system in place and the records we examined showed that identified shortfalls were addressed promptly.

Concerns had been shared with us that the manager's communication style was not always conducive to good staff relationships. The staff we spoke had mixed views about their management style, but told us that they had found them mainly supportive.

We looked at people's care plans as concerns had been raised with us about their quality. We found that they needed to be updated and rewritten as the provider had written them when people were admitted to the service, and added to them as needed to update them. Some people who had used the service for many years, essentially still had the original plan from when they first moved in.

We did not talk with people who used the service on this occasion; we concentrated on checking records and talking with the manager and staff.

When we last visited the service on 6 June 2013 we observed the delivery of care and spoke with three people. We saw that the staff were attentive and interacted with the people who used the service in a friendly, respectful and professional manner.

People told us that the staff knew how they wanted to be supported and that they made sure they got what they needed. One person said, "It's good here." Another person told us that the staff ".... are only ever kind."

The majority of people who lived in Broad Acres were living with dementia and were unable to tell us about the quality of care they received. To enable us to access people's wellbeing we spent time sitting with them observing the care they received and the level of staff interaction.

We observed that the staff were attentive to people's needs. Staff interacted with the people who used the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance.

We saw that the majority of people were provided with suitable and nutritious food and drink, however the dietitian's advice was not always followed for those people who needed extra support to maintain their weight.

We looked at three staff files and found evidence that showed that the staff received supervision and training necessary to effectively care for older people.

We looked at the way that complaints were recorded and dealt with, and saw that they were handled in line with the provider's policy.

People who used the service told us that they were satisfied with the service provided. One person said, "I am very happy living here." Another person said, "I am happy, the carers are very kind."

People told us that they were provided with choices of meals that were of good quality and that they were provided with enough to eat and drink. One person said, "I had a lovely meal thank you." Another said, "The food is good." Another person said, "They (staff) always make sure I have a fresh jug of water in my room."

A person's relative told us that they felt that their relative's needs were met. They said that they and their relative were consulted about the care provided and the staff were respectful in their approach.

A visiting health professional told us that the service provided, "Good care." They also told us that the service made appropriate referrals for health care support.

We tracked the care records of three people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights.