Broughton Lodge

Updated 15 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Expert by Experience made phone calls to people's family members to gain feedback about their experience.

Service and service type

Broughton Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Broughton Lodge also provides care and support to people living in their own homes using the supported living model, so they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had two registered managers, registered with the Care Quality Commission; one for each regulated activity (The care home and personal care in people's own homes). This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave a short period of notice of the inspection to give time for some people who lived in their own homes and their care was provided by Broughton Lodge to give their consent to a visit from an inspector.

Inspection activity started on16 May 2022 and ended on 24 May 2022. We visited the office location on 16 and 20 May 2022.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority quality and safeguarding teams; we also communicated with the local fire and rescue service.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with, communicated with and observed the care and support of eight people who lived at the home. An Expert by Experience also spoke with eight relatives of people who lived at Broughton Lodge about their experience of the care provided.

We spoke with thirteen members of staff including the registered manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included five people’s care records and a sample of people’s medication records. We also looked at a variety of records relating to the management of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found; for example, we looked at quality assurance records.

Updated 15 October 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Broughton Lodge is a residential care home providing accommodation and personal care for up to 20 people. At the time of our inspection 12 people were living at the home. Broughton Lodge is also registered to provide personal care to people living in their own homes; at the time of our inspection one person was receiving personal care in their own home.

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

The service was not consistently meeting the principles of Right support, right care, right culture.

Right Support -

The design of the service and accommodation was not effectively meeting everybody’s needs. Broughton Lodge was institutional in style; it was large and not domestic.

Staff told us many interactions between people who lived at the home were poor and were a significant cause of their anxiety and incidents. The risk that people posed to each other was reduced by staff following strict protocols and at times intervening. However, this did not promote people naturally interacting with each other and having the opportunity to form positive everyday relationships.

Some of the adaptations to the environment had not considered people’s experience.

Some areas of the home were more homely, and people had been supported to decorate and personalise their bedrooms with things that were important to them. Independent advocacy was available for people.

Right Care -

The service operated within the principles of the MCA when supporting people to make significant decisions; using the best interest decision principles. However, in more day to day matters, people’s perspective and opinions were not always sought.

In their interactions staff showed a warm, caring respectful approach towards people. People’s family members told us that their relatives were cared for and treated well. One person’s relative told us, “They seem excellent in caring, genuinely caring and supportive.” Staff spoke to and about people in a dignified and respectful manner; especially when describing times when things have gone wrong.

People received effective and creative support when accessing community healthcare services.

There were a range of initiatives in place that matched different people’s communication styles to help the provider and registered manager listen to people.

Right culture -

Some aspects of the culture within the service were not positive. The service had not consistently promoted ordinary living and had not always dignified people as equal citizens. This was reflected in how the provider had not always considered the experience of people living at the home.

People’s accommodation and care was focused on keeping people safe and was not focused on effectively listening to them and the promotion of people having control over their lives and living an ordinary lifestyle.

Opportunities for learning and improving the care provided were at times lost and not explored or acted upon.

There was evidence that some people had benefitted from the accommodation, care and support provided at Broughton Lodge. Some people had recently moved from Broughton Lodge into their own homes and other people were ready to do this and were planning this move.

Care staff were very positive about their roles. The provider had ensured that a series of checks and audits had taken place at the home to ensure the service provided for people was safe. The registered manager and provider were exploring different ways to support people in the least restrictive manner possible. There had been a recent reduction in physical interventions from staff members.

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 good (published 9 January 2019).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture.

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.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the service providing person-centred care and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We made recommendations regarding reviewing incidents and working with stakeholders to review people’s accommodation needs and choices.

Follow up

We will request an action plan from 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.