Broadoaks

Broadoaks is a residential care home providing personal care for up to 39 older people and people living with dementia in one adapted building. The building was split across two floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia. There were 16 people receiving a service at the time of our inspection.

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

The provider did not have robust safety and quality monitoring processes in place. People's care records were not always up to date or completed appropriately, and the provider's management checks had not identified these gaps in recording.

Staffing levels were not assessed against a dependency tool to ensure that adequate levels of staff were deployed appropriately. Concerns were raised on quality visits conducted by the local authority. People were being left for periods of time in unstaffed areas of the service. The provider has since increased staffing levels to ensure all areas of the service are staffed at all times.

People received their medicines as prescribed and staff had clear information about how people liked to be supported with their medicines. Staff were knowledgeable about people's health needs and the provider had sought support from other health professionals as appropriate to support people's needs.

Staff wore appropriate personal protective equipment (PPE) and told us they knew how to minimise people's risk of infection through safe infection prevention and control processes.

Staff were safely recruited to the service, and were provided with relevant training for the roles they undertook. All staff training was up to date at the time of inspection.

The provider was , working with the local authorities to address concerns they had found.

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 04 December 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and risks to people. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to governance and staffing levels at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

The inspection was completed on the 3 and 5 October 2018 and was unannounced. At the time of this inspection there were 15 people living at Broadoaks.

Broadoaks is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 20 older people and people living with dementia in one adapted building.

The service did not have a registered manager in post, however the manager had submitted their application to be registered with the Care Quality Commission and this was being progressed at the time of this inspection. 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.

Not all risks to people and their care and support needs were recorded and detailed within a care plan document. Though improvements were required, there was no impact to demonstrate people’s care and support needs were not being met or people were being placed at risk of harm and their safety compromised.

People told us the service was a safe place to live and there were sufficient staff available to meet their care and support needs. Appropriate arrangements were in place to recruit staff safely. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow.

Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs to ensure people were safe. Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines.

Staff now received opportunities for training and this ensured staff employed at the service had the right skills and competencies to meet people’s needs. Newly employed staff received a robust induction based on their level of experience in a care setting. Staff felt supported and received appropriate supervision and an appraisal of their overall performance. Staff demonstrated a good understanding and awareness of how to treat people with respect, dignity and to maintain their independence.

Where people lacked capacity to make day-to-day decisions, we saw that decisions had been made in their best interests. People who used the service and their relatives were involved in making decisions about their care and support and staff sought people’s consent prior to providing this.

Where people were at risk of poor nutrition or hydration, this was monitored and appropriate healthcare professionals sought for advice and interventions. People had their nutrition and hydration needs met and the dining experience was positive. People told us their healthcare needs were well managed. Staff were friendly, kind and caring towards the people they supported and the care provided met people’s needs.

People and their relatives told us that if they had any concerns they would discuss these with the manager or staff on duty. People were confident their complaints or concerns would be listened to, taken seriously and acted upon.

Quality assurance arrangements were in place and completed at regular intervals. The registered provider and the manager were able to demonstrate an understanding and awareness of the importance of having good effective quality assurance processes in place. Feedback from people using the service and those acting on their behalf were positive about the care and support provided.

We have made one recommendation about the service’s care planning arrangements.

This inspection took place on 18 July 2017.

Broadoaks is registered to provide accommodation with personal care to up to 20 older people, some of whom may be living with dementia related needs. There were nine people receiving a service at the time of our inspection. The registered manager told us that the reduced number of people reflected the current building works to extend the premises. The registered manager told us it was envisaged that these works would be completed by October 2017.

A registered manager was in post. 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.

Improvements were still needed to ensure that all staff received the training needed to enable them to carry out their role effectively. Although a rationale was provided by the registered manager as to why staff had not undertaken this training, this was not acceptable and action had not been taken by the registered manager or the provider to address this. Additionally, although an induction programme was in place that prepares newly employed staff for their role, no set timeframe for the completion of the ‘Care Certificate’ or an equivalent had been agreed with staff and some staff employed for the period six to 12 months had still not completed this.

Whilst arrangements were in place to regularly assess and monitor the quality of the service provided, these measures were not as robust or effective as they should be. Though the majority of improvements as highlighted at our last inspection in May 2016 had been accomplished, the provider and registered manager had failed to take proactive action to make the necessary improvements required in relation to staff training.

People told us the service was a safe place to live and there were always sufficient staff available to meet their care and support needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people.

Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed to ensure their safety.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff felt supported and received appropriate formal supervision at regular intervals. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure theirs’ and others’ safety.

People who used the service and their relatives were involved in making decisions about their care and support. People’s capacity to make day-to-day decisions had now been assessed.

The dining experience for people was positive and people were very complimentary about the quality of meals provided. Where people were at risk of poor nutrition or hydration, this was monitored and appropriate healthcare professionals sought for advice and interventions.

Care plans accurately reflected people’s care and support needs and people received appropriate support to have their social care needs met. People told us that their healthcare needs were well managed. Staff were friendly, kind and caring towards the people they supported and care provided met people’s individual care and support needs.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

Broadoaks is registered to provide accommodation with personal care to up to 20 older people, some of whom may be living with dementia related needs. There were 14 people receiving a service at the time of our inspection. The registered manager told us that the reduced number of people reflected the current building works to extend the premises.

A registered manager was in post. 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.

Systems to manage risk for people living and working in the service were not safe.The provider's systems to check on the quality and safety of the service provided were not fully effective and had not identified the issues we found. Up to date guidance about protecting people’s rights had not been followed so as to support decisions made on people’s behalf and comply with legislation. Improvements were needed to ensure that all staff received the training needed to enable them to carry out their role effectively.

Staff were knowledgeable about identifying abuse and how to report it to safeguard people. Recruitment procedures were thorough. Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs.

People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences. Arrangements were in place to support people to gain access to health professionals and services. People were supported by staff who knew them well and were available in sufficient numbers to meet people's needs effectively. People’s dignity and privacy was respected and they found the staff to be friendly and caring. Visitors were welcomed and relationships were supported.

People’s care was planned and reviewed with them or the person acting on their behalf. Staff had information on how best to meet people’s needs. People were supported to participate in social activities that interested them and met their needs. People felt able to raise any complaints and felt that the provider would listen to them. Information to help them to make a complaint was readily available.

People knew the manager and found them to be approachable and available in the home. People living and working in the service had the opportunity to say how they felt about the home and the service it provided. Their views were listened to and actions were taken in response.

One person said, "We have regular residents meetings here and have a say in how things are run. Staff here are very polite and support me when I need it. They are very caring and respect my wishes."

The provider managed medicines effectively. Systems were in place to ensure people were protected, their medication was provided when they needed it and that it was ordered on time to ensure that sufficient quantities were available.

There were sufficient numbers of trained and qualified staff on duty at all times. Staff shortages were anticipated so that staffing levels did not fall below the numbers required to provide safe care and support. One person said, "There are plenty of staff available throughout the day and they look after me well."

A complaints procedure was in place and readily available for people to use if they required. It outlined the procedure for making one, who would deal with it and the timeframe involved. People spoken with had not found the need to make a complaint but felt that they would be supported if they did. We were told that the manager and staff were very approachable and dealt with minor issues to their satisfaction.

Improvements had been made to training records, supervision, appraisal and record keeping highlighted at one of our previous inspections.

One person said, "I am very happy here. It is excellent. The staff always have time for me and are very attentive." When we looked at the care plans we found that they were very informative and contained a detailed assessment of health and personal care requirements together with risk assessments. The plans were person centred and met people's needs.

Infection control procedures were good and included measures to protect persons using the service and staff members. A recent food hygiene inspection by Rochford District Council awarded them the highest rating achievable.

Staff we spoke with were happy that they were supported and felt that they had received a good level of training to meet the needs of the people using the service. There was a good staff induction process and supervision records were available for all of the staff records that we viewed.

The provider had systems in place to monitor the effectiveness of the care. This included resident and relative surveys and regular self inspections by the area manager.

The people we spoke with all commented very positively on the levels of care and treatment that were provided and enjoyed their time at Broadoaks.