The inspection visit took place on 22 October 2014 and was unannounced.
This service provides intermediate care, short term respite and dementia care. Broadmeadow is a large purpose built service, and has 43 en-suite bedrooms and five flats situated over two floors. People are admitted to Broadmeadow from a range of settings – acute hospital beds, their own homes and temporary residential accommodation. The service is designed to prevent further admission to an acute hospital, facilitate a prompt return home and prevent admission to permanent residential care.
Broadmeadow can accommodate up to 48 people, and provides care and support for 35 older people, five younger adults with a physical disability, and eight adults with dementia, both male and female. It operates from five units within the same building. These comprise three short term rehabilitation and respite units; one unit for the five flats for respite care; and a dementia unit for respite care and assessment.
The main purpose of the service is for people to receive short term respite care, or be assessed for their rehabilitation needs. They are then supported in making sufficient improvements in their medical health or dementia needs to return home. Some people stay for longer periods of time if they are unable to return home and require social workers to find them long-term placements; or if they are waiting for home circumstances to be made suitable for them. Some people are admitted for respite care, for example, if their usual carer is ill and cannot look after them. The staff work closely with the NHS Intermediate Care Team (ICT), which includes nurses, physiotherapists, and occupational therapists. Referrals are made to other health professionals such as dieticians, speech and language therapists, or psychologists as needed. There is close working with social care professionals to ensure that people’s home circumstances are suitable before they return home.
The service is run by a registered manager, who was present throughout the day of the inspection visit. 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.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and DoLS. Some of the people in the service had been assessed as lacking mental capacity to make some decisions, and there were clear records to show who their representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.
The service had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the local authority’s whistleblowing policy. They were confident that they could raise any matters of concern with their line managers, the registered manager or with the local authority safeguarding team.
The service had measures in place to protect people from risks to their safety. These included building and environmental risk assessments, maintenance checks, regular servicing and checks for equipment, and risk assessments for each individual person receiving care and treatment.
The registered manager carried out on-going checks to assess if there were sufficient numbers of staff on duty. There were suitable numbers of staff in evidence throughout the day, but we identified some concerns about the numbers of night care staff.
We recommend that the provider re-assesses the night staffing requirements for the service, in conjunction with the dependency levels of people using the service.
There were robust recruitment procedures in place. Staff said they were well supported through individual supervision sessions, regular staff meetings, yearly appraisals and daily handovers. Staff were trained in essential subjects during their induction programme; and refresher training was provided at regular intervals. Staff were encouraged and enabled to develop their knowledge and skills with further training courses, and formal qualifications.
People brought in their medicines with them from home or from hospital depending on the reason for their admission. The staff encouraged people to be as independent with their medicines as possible, so as to promote their ability to manage their medicines when they returned home.
The service provided a wide variety of food, most of which was home cooked. People said that the food was very good and they enjoyed it. The catering staff were knowledgeable about people’s different dietary needs, and ensured that people received food that was suitable for them.
Staff were attentive to people’s needs. People said they felt safe and well cared for. Comments included, “They look after me wonderfully, I don’t know what I would do without them”; and “The staff here are lovely and give me lots of encouragement to get moving.” Staff responded to people promptly when they called for help, and spoke to them in a kind and caring manner. People were confident that if they had any concerns they would be listened to, and their concerns would be dealt with appropriately.
People were involved in their care planning, and care plans reflected their individual needs and choices. People with physical health needs knew that the staff were committed to helping them to regain their independence and return home if possible. People in the dementia unit were encouraged to retain their independence, and staff showed empathy in helping them in times of anxiety or confusion.
People, relatives and staff spoke highly of the manager and said that she listened to them, and took their views and comments into account in the running of the service. Recent results from a survey conducted by the provider showed that people rated the service as ‘excellent’, and did not have any concerns. There were different styles of questionnaires for different units, so that people with dementia could more easily relate to the questions being asked.
The manager had a visible presence in the service and was available for people to talk with her on a daily basis. There were regular staff meetings for different job roles, so that staff were empowered to take part in the development of the service, and were fully informed about any changes.
The service was well known in the local community, and maintained good relations with other services. There was innovative working with other agencies to facilitate on-going improvements. For example, the service had recently been awarded a ‘Gold Accreditation’ from Sterling University for the dementia environment. (Sterling University has a Dementia Services Development Centre, to assist services in developing effective care for people with dementia). There was a clear sense of staff working together to achieve high standards of care for people in every unit.