Broadmead Rest home is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Broadmead provides accommodation with personal care for up to 38 people. At the time of our inspection 28 people were living in the home.

At the last inspection, in March 2016, the service was rated overall as good, and in the key questions: is the service effective, caring, responsive and well-led. The key question for: is the service safe was rated requires improvement. This was because safe recruitment procedures had not always been followed and where people were prescribed variable doses of medicines, the amounts given were not always recorded. Actions were taken before the end of the inspection process to address the shortfalls we had identified.

We carried out a comprehensive inspection on 7 November 2018. At this inspection, we found the improvements that had been made following the last inspection had been embedded and sustained.

At this inspection, we found shortfalls in the recording of medicines that required additional security.

The service overall, remains Good.

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.

Sufficient numbers of staff were deployed at the time of our visit. Staff performance was monitored. Staff received supervision and training to ensure they could meet people’s needs.

Most medicines management shortfalls were promptly acted upon and actions taken to make improvements. However, there were shortfalls in the recording and checking of some medicines.

Staff demonstrated a good understanding of safeguarding and whistle-blowing and knew how to report concerns.

People were helped to exercise support and control over their lives. People were supported to consent to care and make decisions. The principles of the Mental Capacity Act (MCA) 2005 had been followed.

Risk assessments and risk management plans were in place. Personal and nursing care was delivered in line with assessed needs and accurate monitoring records were maintained.

Incidents and accidents were recorded and showed that actions were taken to minimise the risk of recurrence.

People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.

Staff were kind and caring. People were being treated with dignity and respect and people’s privacy was maintained.

Care was personalised, highly responsive and sensitive to individual needs.

A wide range of activities were offered and provided people with entertainment and engagement in communal areas, in their rooms and outside of the home.

Systems were in place for monitoring quality and safety. Where shortfalls were identified these were acted upon.

This unannounced inspection took place on 29 and 30 March 2016. Broadmead Rest Home (Broadmead) is a residential care home without nursing that offers a service for up to 38 older people. At the time of our inspection there were 17 people living at Broadmead. Some people had varying types and degrees of dementia or associated mental health conditions.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We last inspected Broadmead on 2 April 2014 and judged the provider to be in breach of regulations. People who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. We judged that this had a moderate impact on people who used the service, and told the provider to take action. We saw evidence that although work had been completed in relation to the annexe there was no evidence available to confirm that the works completed had met the requirements of the fire department or the health and safety requirements of the local authority. We told the provider to produce an action plan in relation to the safety and suitability of the annexe premises. During this inspection we found the provider had followed their action plan and had made necessary improvements to meet the legal requirements to provide a safe environment for people to live in.

The provider had an emergency business and continuity plan for the home. Fire safety precautions and equipment were checked regularly. Evacuation procedures had been practiced to ensure they were safe and effective. Utilities, such as gas and electricity were routinely checked under contract and the maintenance staff ensured that repairs were completed promptly. Safety tests in relation to the presence of asbestos and Legionella bacteria had been carried out under contract within six months of our inspection.

Not all staff that we spoke with felt that there was always enough staff to meet people’s needs effectively. Some staff told us how they sometimes felt ‘rushed’ and ‘people had to wait longer for assistance at busy times of the day, such as mealtimes'. People and relatives told us staff always responded promptly when required. During our inspection we observed the deployment of staff worked well and people’s needs were met swiftly. Rotas confirmed that there were always sufficient suitably qualified staff deployed to meet people’s needs safely.

Staff had undergone relevant pre-employment checks as part of their application. However, the provider had not always followed safe recruitment procedures by fully exploring gaps recorded in staff previous employment.

We observed medicines administered safely in a way people preferred, by trained care staff who had their competencies assessed annually by the registered manager. However, where people were prescribed medicines to be taken when required, such as pain relief, staff had not always recorded the quantity that they had administered.

People told us they trusted the staff who made them feel safe. Staff had completed safeguarding training and had access to relevant guidance. They were able to recognise if people were at risk of abuse and knew what action they should take if required. Since the last inspection the provider had reported seven safeguarding incidents which had been investigated and reported by the registered manager. We noted that the required learning and appropriate staff supervision had been implemented as a result of these incidents.

People’s needs had been appropriately assessed and reviewed regularly. Their safety was promoted through individualised risk assessments. Where risks to people had been identified there were plans in place to manage

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-

The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff who supported them and from looking at records. We reviewed twelve people’s records; we spoke with six people who used the service, four people’s relatives, seven staff and the provider, about the service.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At the inspection on 23 October we found that the provider was not providing a safe environment for people to live in. Following our inspection the provider took action and moved people from the original house to the annexe and limited the number of people they accommodated whilst they completed the required works. We found at this inspection that although the old house was no longer occupied the provider had not taken action to ensure that the required works had been completed so that this part of the home could again be used to provide the regulated activity. We saw evidence that although works had been completed in relation to the annexe there was no evidence available to confirm that the works completed had met the requirements of the fire department or the health and safety requirements of the local authority. We have set a compliance action in relation to the safety and suitability of the premises. We have arranged for the provider to meet with us in order for them to provide us with evidence of how they intend to ensure that the old house will be fit for purpose and will meet the required standard in order to provide the regulated activity.

Systems were in place to receive, store and administer medicines. Records were kept of the medicines administered and supporting information to ensure staff administered medicines consistently. This ensured people received their medicines as prescribed.

We saw that the provider had made improvements to the standard of record keeping and there was overall consistency in the records kept in relation to people’s care and staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw evidence that the service was aware of how to make referrals and had done so in the past to help protect people.

Is the service effective?

We found that people’s written and verbal consent had been sought in relation to the provision of their care. Where people lacked the capacity to make a decision we saw evidence that best interest decisions had made on their behalf in accordance with the relevant legislation. Staff had received relevant training. We identified areas that the provider could further improve and these were discussed with the provider at the time of the inspection.

People had care plans in place that identified their needs and risk assessments. People had risk assessments in place that there were based on relevant clinical guidance. People’s care had been provided as per their care plan. We identified areas that the provider could further improve and these were discussed with the provider at the time of the inspection.

People had nutrition care plans in place and tools had been used to identify when people might be at risk from weight loss. Relevant information in relation to people’s dietary needs had been made available to the kitchen staff. We identified areas that the provider could further improve and these were discussed with the provider at the time of the inspection.

Staff had undergone an induction and received ongoing support through the provider’s supervision and appraisal process.

Is the service caring?

Staff were observed to be caring and positive in their interactions with people. People we spoke with told us “I like it here, they are lovely. I think they know my needs.” and “They are fine, life here is good.” One person’s relatives commented “Staff appear competent and treat everyone with respect.” Another said “Staff interact well with dad.” People were cared for by staff that were caring in their attitude.

Is the service responsive?

We saw evidence of a recent resident’s meeting and following the inspection the provider sent us evidence that their annual survey was about to be circulated in order to seek people’s views on the service. People told us “There’s no comparison; it’s so much better.” We saw evidence that where people needed to engage with other services such as a GP or dietician arrangements had been made for them to do this. We saw evidence that audits of the service had been completed and used to develop action plans.

Is the service well-led?

There was no manager registered with the Care Quality Commission for this location. We spoke with the provider and we were provided with assurance that the provider had taken appropriate action to ensure that there would be a registered manager shortly. There had been considerable changes at the home in recent months and the provider had to ensure that the changes implemented were sustained. In particular, the service was still undergoing consolidation of the management team. The provider was able to demonstrate to us that they had taken action to ensure continuity for people during this period. A care consultant had been working with the home management for a period of months and we were supplied with evidence that this arrangement was to continue.

We last inspected Broadmead Rest Home in October 2013. We found the provider was not meeting seven of the essential standards of quality and safety. On the 30 December 2013 we undertook a further inspection of Broadmead Rest Home. We found the provider had made adequate improvements to three of the essential standards for care and welfare, safeguarding people from abuse and supporting workers. A further inspection will be undertaken at a later date to measure compliance against the four remaining essential standards. During our inspection in December 2013 we found the provider was not meeting two further essential standards of quality and safety for consent to care and treatment and meeting nutritional needs. Two Care Quality Commission compliance inspectors were joined by a nurse specialist. We observed care in the home, reviewed twelve care plans and spoke with four people, their relatives and a GP.

Since the previous inspection in October 2013 the operations manager had left the organisation. The home is currently being managed by an interim manager with support from a care consultancy company. At the time of inspection there was no registered manager at this location.

People were mostly asked for their consent before care and treatment was provided. However, we found only one care plan had a consent to care and treatment form completed and signed. Staff had limited knowledge of the Mental Capacity Act and how this impacted upon people who did not have the capacity to make decisions about their care and treatment.

Observation of practices during our inspection showed that most people received effective, safe and appropriate care, which was designed to meet their specific needs. One person said "The staff are good to me and I am extremely happy with my care".

We found that people were not always protected from the risk of inadequate nutrition. This was because actual physical care was not consistent with people’s nutritional care plans and information recorded for catering staff when preparing meals.

People who lived at Broadmead Rest Home were protected from the risk of abuse. This was because staff had received appropriate training and understood how safeguarding principles applied to their roles. The people we spoke with told us that they felt safe living in the home.

We found that staff had received suitable supervision and training. There were plans in place for all staff to receive further training and appraisals by 31 March 2014.

We last inspected Broadmead Rest Home in June 2013. We found the provider was not meeting two of the essential standards of quality and safety. On the 23 October 2013 we undertook a further inspection of Broadmead Rest Home. Two Care Quality Commission (CQC) compliance inspectors were joined by a nurse and pharmacy specialist. We observed care in the home, reviewed ten care plans and spoke with four people and their relatives.

Since the previous inspection in June 2013 the registered manager had left the organisation. The home is currently being managed by an operations manager with support from a care consultancy company. There is currently no registered manager at this location.

We found that people were not always cared for in a way that ensured their safety and welfare. One relative told us “I have noticed a significant deterioration in the standards in the home over the last six months.”At the last inspection in June 2013 the provider was asked to make improvements to achieve the essential standard. At the recent inspection we found that very minor improvements had been made but people still received inappropriate care and treatment.

People told us that they felt safe living at Broadmead Rest Home. We saw records to confirm that not all staff had undertaken safeguarding training. Most staff were unable to tell us how they would report concerns or identify poor practice which could be considered a safeguarding concern. We found that people were not always protected from the risks of injury or harm.

The administration of medications was not conducted or monitored effectively. We found processes which identified that people were not always being given their medication at the correct intervals or at the times prescribed.

Broadmead Rest Home was not adequately maintained and parts of the home were not always fit for purpose. We found people were at risk of falls and injury because health and safety issues were either not identified or addressed.

Staff were not suitably supported to provide an adequate level of care and treatment. At the last inspection in June 2013 the provider was asked to take corrective action in this standard. At the recent inspection we found that very minor improvements had been made. However, staff working in the home had not received an induction, training and supervision to support them in their roles.

There were no effective systems in place to identify, assess and manage the risks relating to health, welfare and safety of people living in the home. The provider had not paid full regard to the the previous CQC inspection report and failed to make the improvements required by the compliance actions.

Records were not accurate and did not protect people from the risks of unsafe and inappropriate care and treatment. Staff provided care for people, which was not as described in their care plan. Records were also inconsistent and staff reported that they were sometimes unclear of the care they needed to provide to people.

We found that people who lived in the home were treated with dignity and respect. We saw that staff supported people to make decisions about their care.

We found that people’s care plans had incomplete information and risk assessments. The person centred information was also not completed or limited. However, people told us that they felt well cared for. One person told us “If it wasn’t for the staff here I don’t know where I would be” and “They have helped me to enjoy life again”.

People were protected from the risk of abuse. The people we spoke with told us they felt safe living at Broadmead. A local GP told us they had no concerns about the home.

We found that staff were not always supported to provide safe and appropriate care. The manager told us that she observed staff working practices. However, we found that staff did not have regular supervision or an annual appraisal.

The provider asked for people’s views and feedback. We saw evidence of positive feedback where people reported the service to be good or excellent.

We spoke with four people who lived in the home, the deputy manager and manager.

We found that people were involved in their care planning and were treated with dignity and respect. People said ‘’staff always, always respect me.’’ People were encouraged to make their own decisions and choices, where they were able. People told us that staff helped them to make decisions for themselves. Care was planned to meet people’s individual daily care and health needs. People told us that they were ''well looked after.''

We used a number of different methods to help us understand the experiences of people using the service. This was because the people using the service had varying degrees of dementia which meant they were not able to tell us their experiences. We contacted other people connected to the home shortly after our visit. We spoke to a healthcare professional who told us there appeared to be enough staff on duty whenever they visited, however, staff changed frequently and there were language barriers for some staff.

We spoke with three relatives of people living at Broadmead. Generally they were satisfied with the care and support provided, but all stated there was a language barrier between some staff and their relative.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed staff treating people with kindness and patience.