This inspection was completed on 16 and 17 January 2108 and was unannounced.

Broadhurst 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. Broadhurst accommodates 25 people in one adapted building. There were 22 people at Broadhurst at the time of the inspection.

There was a registered manager in post at the service. 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 about how the service is run

The previous inspection was completed in October 2015 and the service was rated Good overall. At this inspection the service remained Good.

We have provided two recommendations within this report to support the provider to complete the improvements they had started making to the home environment and people’s end of life care planning prior to our inspection.

Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, action had been taken to ensure the on-going safety of the person.

Staff had received training appropriate to their role. Staff had received training around safeguarding and were confident to raise any concerns relating to potential abuse or neglect. The administration and management of medicines was safe. There were sufficient numbers of staff working at Broadhurst. There was a robust recruitment process to ensure suitable staff were recruited.

People were supported to access health professionals when required. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities. People were supported in an individualised way that encouraged them to be as independent as possible. People were given information about the service in ways they wanted to and could understand.

People and their relatives were positive about the care and support they received. They told us staff were caring and kind and they felt safe living in the home. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and were able to describe what they like to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans were person centred to guide staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care.

The service was well led. Quality assurance checks were in place and identified actions to improve the service. Staff and relatives spoke positively about the management team.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Systems were in place to ensure the home was well maintained and equipment was serviced regularly. There were enough staff on duty to meet people's needs in a safe and unrushed way.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applied to care homes. We saw an application had been made and approved with the necessary input from other authorities. Staff had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards and demonstrated knowledge of these.

Staff had completed training in the safeguarding of vulnerable adults. They could describe different types of abuse and how it could be determined if someone was being abused. All the staff we spoke with were knowledgeable about the home's safeguarding policy and local procedures for reporting suspected abuse and felt confident to use these. Risks to people’s health and safety had been assessed and management plans were in place to reduce these risks.

Is the service effective?

People we spoke with told us they were happy with their care. They said all their care requirements were met. One person told us, "I have everything I need, and if I don't, they get it for me". A visitor we spoke with said, “they look after everything. The other day [my wife] was not too bright, and within half an hour the doctor had been called and was seeing to her”. Staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills to care for people living in the home. Where appropriate, the service sought advice from appropriate professionals to assist with the care provided for people.

Is the service caring?

People were supported by staff who were attentive to their needs. They did this in a supportive and patient way. We observed staff reassuring people and assisting them to move around the home in an unrushed and gentle way. One person told us, “I have no worries at all. The girls are lovely”. A visiting relative told us, “they are second to none. 100%. I have no complaints at all”. Another relative said, “I’m booking my place in here, definitely”.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Care files included details of how to care for each person, including their personal preferences. People told us they could change any aspect of their care, and that their needs were discussed with them regularly. Records of daily care showed people were cared for according to their care plan and their needs were met. A visiting relative told us, “they are very co-operative. If [my wife] wants to eat breakfast in her room, or get up late, there is no problem with that. Her choices are accommodated”. A member of staff provided a variety of activities throughout the week, including arts and crafts, music and quiz sessions. People had access to a hairdresser in the home, and could have manicures if they wished.

Is the service well-led?

Quality assurance systems were in place. A provider report was produced each month which outlined changes to people’s health and welfare as well as the details about the maintenance of the home, and staffing issues. We saw some people living in the home, and their relatives, had completed an annual questionnaire about the quality of the service provided in the home. Comments from the survey were all positive most rating the service at 9 or 10 indicating good or excellent. Where people had made suggestions or requests, these had been collated into an action plan and had been implemented where possible. The manager had contacted the respondents to inform them of changes that were made in response to their comments. Staff told us the management team were supportive and always available for advice and help. A delegation list ensured all staff knew their duties on each shift and this was monitored by the manager and head of care. People living in the home were consulted about changes to the home, for example, the purchase of new furniture.

We spoke with four of the 22 people living in the home. They all said they were comfortable and happy with the care they received. We also spoke with two health professionals who visited the home. They said they had “no real concerns” about the care provided at the home. However, we found staff were not aware of specific parts of people’s care related to their health and wellbeing. We also found the home’s system to ensure staff were kept up to date with changes in people’s care was not being used effectively.

People looked clean and well-presented and the communal parts of the home were clean. However, we found some communal toilets and bathrooms were not clean. We also found some equipment was not in good repair which meant it could not be cleaned effectively.

The home had a quality assurance programme in place. This meant the views of people living in the home and their family members were sought on a regular basis and acted on. We also found a number of audits were carried out and action taken as a result to improve the service.

This inspection took place on 6 and 9 October 2015 and was unannounced.

Broadhurst is a residential care home for people requiring personal care. A maximum of 25 people can be accommodated and at the time of our inspection there were 22 people living in the home some of whom had physical disabilities or a diagnosis of dementia. Care is provided over three floors, and there are several communal dining and lounge areas and an enclosed garden.

At the time of our inspection the manager had applied to be registered with CQC and their application was being processed. 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.

People said they felt safe in the home and with staff. Staff were knowledgeable about the signs of abuse and how to report their concerns. There were sufficient staff to meet people’s needs and support was provided by the manager when staff were on leave.

Staff respected people’s privacy and dignity. People were asked for their consent before care was delivered; however, care records for people who lacked capacity to make some decisions did not contain information on how the assessment had been made. We have made a recommendation to the provider about this.

Staff received regular training and supervision, although staff had not been trained to care for specific needs of some people, such as those with a learning disability. We have made a recommendation to the provider about this.

There were sufficient staff to meet people’s needs safely and checks were carried out on staff suitability before they started working in the home. Risks to people’s health and wellbeing were assessed and staff knew about these and how to reduce them. Food was plentiful and varied and people said they enjoyed the homemade meals and desserts.

People received their medicines in a safe, unhurried manner. The home was clean and staff followed procedures to prevent and control the risk and spread of infection.

People said staff were caring and compassionate. Staff knew people’s preferences and respected these. They went out of their way to support people to attend trips and a large variety of individual and group activities were arranged. Innovative ways to encourage people to socialise were used and had been successful in preventing people from becoming socially isolated.

The manager was supportive and involved staff and people living in the home in decisions about improvements to the home. People’s feedback was acted on and wherever possible their requests were provided.

Complaints were taken seriously and responded to in a timely manner. Audits of care records and processes in the home were completed, and any issues found were addressed. The quality of care was monitored by the manager, who worked alongside staff regularly. Staff were honest and open and were given feedback about their performance.