Broadland House Residential Care Home

Broadland House is a residential care home providing personal care to 20 people aged 65 and over, some of whome were living with dementia, at the time of the inspection. The service can support up to 20 people.

Broadland House accommodates 20 people in one adapted building.

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

Actions to manage risks had not always been taken. The inspection identified several environmental risks which placed people at risk of harm. Actions had not been taken to fully assess people at risk of malnutrition. Quality Assurance systems had not been effective at identifying or addressing and improving these areas in a timely manner.

The service was open and inclusive which empowered staff in caring for the people who lived at the service. There had been a change of manager and the structure of how the service was being managed was being reviewed. However, during this the time the feedback from staff and relatives of people who lived in the service was positive with the managers being approachable and proactive in supporting people and staff. The staff had felt valued during recent times of COVID-19, receiving gifts and support for their wellbeing.

People’s records were regularly reviewed, were person centred and easy to understand.

Relatives spoke positively about the service regarding how they had been kept in contact with and updated during COVID-19. They were pleased with the care received and felt they could approach staff with queries and concerns and be listened to. Professionals involved with the service said staff were always helpful, notified them of any changes and were open to consider new strategies and ways to help support the people who lived in the service.

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 26 October 2019).

Why we inspected

We received concerns in relation to the management of medicines, environment and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 assessing risk, safety monitoring and management and continuous learning and improving care sections of this full report.

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

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

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 monitor the service.

We have identified breaches in relation to safe care and governance at this inspection.

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

Follow up

We will request an action plan for 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.

• Planning and management of visitors including comprehensive risk assessments, which was clear, easy to follow and covered all areas, both for end of life care and socially distanced visits in the garden

• The people who used the service were supported to keep in touch with their family members via a variety of methods including video conferencing, writing letters and the telephone. The service sent photographs of people to their family members to further aid communication

• Covid-19 action boxes were placed outside people's rooms who were positive or suspected of having the virus, which contained all that was required for supporting them whilst isolating in their rooms, including posters for their door detailing dates of isolation.

• Detailed contingency plans were in place in the event of a virus outbreak. These included maps of the building demonstrating how they would manage during an outbreak.

• One person who used the service had been tested positive for Covid-19. Due to the robust infection prevention and control systems in place, the service had contained the virus and prevented it from spreading further.

• The home was part of a pilot with the Enhanced Care Home Team which allowed them access to extra support for health care needs. This included a nine week programme where staff were tested for covid-19 twice per week, which helped mitigate risks associated with Covid-19

• When staff or people who used the service were tested positive, the service looked at ways this could have happened and put measures in place to lower risk of reoccurrence.

• Staff uniforms were changed so they were more practical and staff were given more sets so they could easily be worn once and washed. Scrubs were also provided at the height of the pandemic.

• The service had increased it’s cleaning regime to further mitigate the risks associated with Covid-19 and the registered manager completed regular audits to ensure compliance

Further information is in the detailed findings below.

Broadland House is a residential care home providing personal care to 19 people aged 65 and over, who live with dementia, at the time of the inspection. The service can support up to 20 people. Broadland House is a period building with accommodation over two floors. It specialises in providing care for people who live with dementia.

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

The service achieved good outcomes for people and everyone we spoke with told us they would recommend the service. One relative we spoke with said, “I would recommend the home, definitely. They are very kind. It’s the next best place to a person’s own home.”

The management team were knowledgeable, consistent and approachable. They inspired an open, supportive and empowering service that benefitted those that used it and their families. They were committed to continually making improvements and involving people. The service was monitored closely and in a variety of ways meaning any concerns were identified quickly and rectified promptly. Staff worked regularly and closely with other stakeholders to ensure a high-quality, safe and appropriate service was delivered. The wider community were also involved.

People received individualised care from enough safely recruited staff that were trained, supported and knowledgeable. People’s needs were assessed on a regular basis and care adapted to meet any changing needs. People received their medicines as prescribed and their health and nutritional needs were met by a service that worked with others to achieve this. Individual risks to people, as well as those associated with the premises and equipment, were identified and mitigated to keep people safe. Staff had received training in safeguarding people and knew how to identify and report any concerns.

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. They received care in a considerate and thoughtful manner that promoted their dignity and encouraged independence. People received care from staff who were respectful of them, and each other, and who showed they knew people, and their needs, well. The home had a nurturing culture that benefitted all.

The home met people’s needs but was tired in places; refurbishment was ongoing. People were happy with the service they received but told us they would feel comfortable in raising any issues they may have. The service saw complaints as a learning opportunity to further enhance the service delivery.

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 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Broadland House Residential Care Home provides residential care for up to 20 people, some of whom may be living with dementia. At the time of this inspection there were 18 people living in the home. Most of these people were living with dementia.

Accommodation is over two floors and is serviced with a lift. The home has 16 single rooms and 2 double rooms. Six rooms have en suite facilities with others housing a sink. A number of communal areas are available to those living there as well as an enclosed and accessible garden.

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.

The service had procedures in place that minimised the risk of employing people not suitable to work at Broadland House Residential Care Home. New staff received an induction and support. All staff received on going and regular training that assisted them to provide appropriate, safe and effective care and support to those living at the home.

Staff morale was good amongst the staff and people benefited from receiving support from staff who were happy in their roles. Staff felt valued, supported and listened to. They received regular supervisions and support. Good team work was evident and this contributed to a service that was organised and efficient.

There were enough staff to meet people’s individual needs. Staffing levels were consistent and the provider employed additional staff not included in the care staff numbers to ensure needs were met. This meant that, if the service experienced any last minute staff shortages, additional staff were available to help meet people’s practical care and support needs.

Care and support was delivered in a kind hearted, courteous, patient and respectful manner. People’s dignity, privacy and confidentiality were maintained and choice was encouraged and supported. Staff understood the importance of gaining people’s permission before assisting them.

Procedures were in place to help protect people from the risk of abuse. Staff had knowledge of how to prevent, protect and identify potential abuse although not all staff had knowledge in how to report concerns outside of their organisation. The management team liaised with the local safeguarding team as required, although not all concerns had been reported to CQC as expected.

The risks to individuals had been identified and staff had knowledge of these and how to minimise them. However, the risks had not always been recorded. Risks relating to the building, working practices and potential adverse events had been identified and appropriately managed. Accidents and incidents were recorded and used to minimise future risk.

People received their medicines as the prescriber intended and the service followed good practice guidelines. Medicines records were accurate and complete although it was not always easy to quickly locate relevant information. The service ensured actions were taken to rectify this following our inspection.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service adhered to the principles of the MCA but staff knowledge on the legislation was variable. However, this did not negatively impact on the service people received but the risk of this in the future was present.

People had individual care plans in place that they, or their family members if appropriate, had been involved in. People’s needs had been regularly reviewed and the care and support changed as appropriate to meet those needs. People had given their consent for care, support and treatment although these were sometimes signed by relatives who did not have the legal authority to make such decisions.

People enjoyed the activities the service provided although some people felt there weren’t enough of these. Staff were limited in when they could assist people with their leisure needs which tended to be in the afternoons. The service had gathered information on people’s life histories, family circumstances, likes and dislikes and used this to develop meaningful relationships with them. Staff knew the people they supported well and this aided their relationships with people.

The healthcare professionals we spoke with talked positively about the way the service met people’s health and welfare needs. The people who used the service, and their relatives, agreed. People had prompt and appropriate access to health care and the service was proactive and preventative in their approach to this.

People’s nutritional needs were met and they had enough to eat and drink. They told us that they enjoyed the food the service provided and that they had a choice.

The service had a positive ethos that welcomed suggestions and feedback in order to develop and improve the service. Systems were in place to monitor the quality of the service and actions taken when issues were identified. The management team demonstrated an open and progressive attitude towards service development.

People spoke of a management team that were visible, approachable, supportive and helpful. An open, transparent and positive culture was encouraged and this aided the support people who used the service received. The home was organised, efficient and had a welcoming atmosphere. The registered manager and provider had a robust overview of the service and were fully involved in its delivery. People told us that they would recommend the service to others.