Broadland View Care Home

Broadland View is a residential care home providing accommodation and personal care to up to 26 people in one adapted building. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 24 people using the service and 1 person was in hospital.

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

People using the service and relatives gave us positive feedback about the service and told us they felt the care was good. However, our inspection identified some concerns relating to the management of risk and safeguarding. This led us to question the quality of the leadership of the service and provider oversight.

Safeguarding concerns had not always been referred to the local authority for investigation or reported to CQC. Where safeguarding concerns had been identified by the provider, they did not always take prompt and effective action to protect people. Staff had not always been appropriately referred to the Disclosure and Barring Service (DBS) to review their safety and suitability to work with vulnerable people. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Risks relating to choking, falls management for people taking blood thinning medicines and some environmental risks were not robustly managed and fully understood by staff. Some environmental risks had been identified but not addressed which placed people at risk of harm.

Records were person centred and had recently been reviewed. However, further work was needed to make sure all records were accurate, and information recorded in the correct place to ensure effective oversight of people’s health and welfare.

Medicines were well managed, and people received their medicines as prescribed. Some recent medicines administration errors had not been fully investigated at the time they occurred. The registered manager assured us better medicines management systems had been put in place following this and records confirmed this.

There were enough staff and staff knew people’s preferences well. They were very kind and relationships were good. The service had a ‘homely’ feel which relatives commented on. One relative stated, ‘I find the service responsive to people’s needs’.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

This inspection reflected a mixed picture. Feedback about the service was positive and people who used the service were happy. However, poor management of safeguarding and risk led us to question the quality of leadership and provider oversight.

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 2 December 2017).

Why we inspected

We received information in relation to a historic incident which occurred before the current registered manager and deputy were in post. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The provider took action to begin addressing our concerns relating to oversight of risk and the management of safeguarding. They introduced new systems of checking daily records, begun a complete review of all care plans and held a staff meeting to remind staff about some key issues raised during the inspection process. They have also begun an action plan which they will share with us.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Broadland View Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches of regulation in relation to the management of risk, safeguarding and overall leadership. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We undertook an unannounced comprehensive inspection of Broadland View on 08 November 2016. We found continued breaches in Regulations 9, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was from a previous visit in September 2015. The service had failed to ensure that people's emotional and social needs were assessed and met. The management of the service had failed to have effective systems and processes in place to monitor and improve the safety of the service provided. For the Regulation 17 breach of Good Governance, we served a warning notice informing the provider that they had to comply with this regulation by 3 March 2017.

At that inspection, we also identified additional breaches of Regulation 11 and 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the service had failed to ensure people consented to the restrictions put in place surrounding people’s freedom of movement. The service had also failed to ensure that all peoples nutritional and hydration needs were met.

We undertook a focused inspection on 19 April 2017. This was to check the service had met the conditions in the warning notice and whether they now met the legal requirements for Good Governance. We found the service had made improvements and were no longer in breach of this regulation. We found that action had been taken to improve how the service assessed, monitored and improved the quality of the service provided. We did not improve the rating for well-led from requires improvement because to do so requires consistent good practice over time.

This inspection was completed to check that improvements to meet legal requirements planned by the provider after our 8 November and 19 April inspections had been made and sustained. The team inspected the service against the five questions we ask about services: is the service safe, effective, caring, responsive and well led. This is because previously, the service was not meeting some legal requirements.

Broadland View 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.

Broadland View accommodates 25 people in one adapted building. There were 25 people living in the home on the day of our inspection. The home supported people who were over 65 years of age, some of whom were living with dementia.

There was a registered manager 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 of the Health and Social Care Act 2008 and associated regulations.

At the inspection on 8 November 2016 we found there was a lack of knowledge and understanding in regards to when a Deprivation of Liberty Safeguards (DoLS) application was required. The service was therefore not acting in accordance with the Mental Capacity Act 2005/DoLS and seeking to reduce the restrictions as far as possible. These concerns constituted a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always involved in decisions about what they wanted to eat. We found food looked unappetising. For people who could not have a conversation with staff about what they wanted to eat and drink, the management team had not considered other ways of gaining this information. These concerns constituted a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People did not always receive care which was person centred and responsive to their needs. This constituted a continued breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this visit, we found sufficient improvements in all of these areas. People’s capacity to consent to care was properly considered and the home worked in accordance with current legislation relating to the MCA and the DoLS. This included training for all staff on both subjects. People appeared happy and were relaxed and comfortable with staff. People had sufficient to eat and drink and were supported by staff to maintain a healthy diet. Observations of meal times showed these to be a positive experience, with people being supported to eat a meal of their choice and where they chose to eat it. Staff engaged in conversation with people and encouraged them throughout the meal, noting who liked to sit with whom. People were supported by staff who understood their needs and abilities and knew them well. Staff were kind and caring towards people and upheld their privacy and dignity at all times. Therefore the actions had been completed and the provider had now met those legal requirements.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People who were able to said they felt safe at the home.

People’s care records showed risks to their safety were assessed and the action needed to mitigate those risks. These assessments and care plans were reviewed and updated at regular intervals to ensure people's changing needs were met. Environmental risks such as hoist equipment, wheelchairs and legionella checks were managed effectively through prompt and regular servicing.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

There were sufficient numbers of staff to meet people's needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed. Newly appointed staff received an induction to prepare them for their work. Staff had access to a range of training courses and said they were supported to attend training courses.

People's health care needs were assessed monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks.

Staff working in the home were caring and compassionate. Staff knew the needs and preferences of the people they cared for and people were given reassurance and encouragement when they needed it. Where people needed support in order to make their own day-to-day decisions this was provided by staff. Where people had short term memory loss, staff were patient in repeating choices each time and explaining what was going on and listening to people's stories. People's rights to privacy, dignity and independence were taken into account by staff in the way they cared for them.

Each person's needs were assessed and this included obtaining a background history of people. Care plans and assessments were comprehensive and showed how people's needs were to be met and how staff should support people. Care was individualised to reflect people's preferences.

People looked comfortable and happy moving around the home, some people stopping for rests or a nap, other people enjoyed having a late breakfast, doing a crossword or reading the newspaper. Staff were always visible to interact or sit with people. People were offered a wide range of both group and individual activities that were meaningful to them and which had a positive impact on their lives.

The home had been decorated and arranged in a way that supported people living with dementia. The service was brightly decorated and stimulating for the people living there. The communal areas of the service were clean and well-furnished with a homely feel. People's rooms were individualised, with personal items such as ornaments, photos and furniture. The outside area was accessible with paths and benches.

Complaints were listened to and managed in line with the provider's policy. Relatives felt welcomed at the service and people and relatives said that they would be confident to make a complaint or raise any concerns if they needed to.

People and their relatives were involved in developing the service through meetings. People, relatives, healthcare professionals connected to the service and staff were asked for their feedback in annual surveys. All responses were positive from the recent quality assurance questionnaire. Their views were valued and they were able to have meaningful input into the running of the home, such as activities they would like to do, which mattered to them.

Staff felt the registered manager was supportive and said there was an open door policy. Relatives spoke positively about the care their family members received. There were effective quality assurance processes in place to monitor care and plan on-going improvements. The provider visited the home on a weekly basis and supported the registered manager.

We undertook this focused inspection on 19 April 2017, to check that the service had met the warning notice and whether they now met the legal requirements. This report only covers our findings in relation to the warning notice. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Broadland View Residential Home on our website at www.cqc.org.uk.

Broadland View Residential Home provides care for up to 25 older people, some of whom were living with different forms of dementia. The home is over two floors and was a former private dwelling. At the time of this inspection, there were 24 people living in the home.

There was a registered manager 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. For the purposes of this report the registered manager will be referred to as the manager. There was also a ‘head of care’ and a private consultant. The private consultant was supporting the manager and the provider of the home.

At the last inspection carried out in November 2016, we asked the provider to take action to make improvements in the management and governance of the home. These actions had been completed. However, the rating remains the same as a period of sustained improvement is required in order for us to have confidence that these changes have been imbedded into everyday practice.

The service had effective systems in place to assess and monitor the quality of care people received. These systems helped to drive improvements in the service, which was noted at this inspection.

Audits had been introduced since our last inspection and these helped to monitor the standard of care delivered. These included audits around people’s dining and meal experiences, how staff interacted with people, the quality of care plans, and the competency of staff to perform their roles effectively.

At this inspection, sufficient improvements had been made by the service and they were no longer in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We concluded that the conditions of the warning notice had been met by the manager and the provider.

This inspection took place on 8 November 2016 and was unannounced.

Broadland View which was formally known as Shalom provides accommodation and support to a maximum of 25 older people, some of whom may be living with a form of dementia. At the time of our inspection there were 23 people living in the home. Broadland View comprises of accommodation over two floors. There are two bedrooms which are shared.

At our last inspection in September 2015, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person centred care, staffing, the safety of the premises and governance of the home.

At this inspection carried out in November 2016, we found continued breaches in Regulations 9, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found additional breaches of Regulation 11and 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

There was a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. During this report the registered manager will be referred to as the manager. There was also a deputy manager in place. At some points of the report we make reference to the management team, this relates to the registered and the deputy manager.

People did not always have thorough risk assessments with guidance for staff on how to manage particular risks to people’s health needs. Some cleaning products were not stored in a secure place. We found some unsafe practice with supporting people to mobilise.

People’s hydration and nutritional needs were not always being met by staff. People did not always receive the support they needed when they were eating and drinking. We found issues with the timings of meals, there were limited choices of what people had to eat and drink.

Staff did not always respond to people’s request for assistance. People’s dignity was not always protected. Staff were not fully responding to people’s social needs who lived in the home. There was a lack of social stimulation for many people in the home. Staff did not have the time to spend talking with people.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was depriving some people of their liberty in order to keep them safe. However, the service was not following the recommendations of one person’s DoLS. The service was not always complaint with the MCA.

There were organisation and planning issues with how staff were deployed around the home. There was also a lack of monitoring and testing that staff had the knowledge and skills to meet people’s needs. There was a lack of effective monitoring of the quality of the service. The audits which were completed were not robust.

People benefited from being supported by staff who were safely recruited, trained and who felt supported by the manager. There were enough staff to meet people’s physical care needs.

Staff understood how to protect people from the risk of abuse and knew the procedure for reporting any concerns. The service responded positively to a change in people’s health needs.

The service encouraged people to maintain relationships with people who were important to them. People’s relatives and friends were welcomed to the service and encouraged to visit.

We found that people were cared for appropriately and the home and its staff acted to ensure that people's care and welfare was maintained. Care planning was accurate and responsive and staff interacted positively with the people they were caring for.

We spoke with the relatives of four people using this service and each person expressed satisfaction with the service their loved one received. One relative told us, “Everything is fantastic; I can’t praise the home enough. It’s like one big family”. They further commented, “I could not fault the care, they turn (for pressure area care) and change [my relative] without fail.” A second relative commented, “The staff are wonderful and always very quick to help – my [relative] is happy enough.” A third relative told us that they thought the home met their relative's needs and they had no complaints.

Concerns were raised about the cleanliness of people’s bed clothes. On the day of our inspection however, all bedding checked was clean and fresh.

There were effective medication systems in place at the home.

Staff were trained and supported to undertake their roles and care for the people living at Shalom.