This inspection was carried out on 19 July 2018. The inspection was unannounced.

Broadmeadow 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.

Broadmeadow is a purpose built service and provides intermediate care, short term respite and dementia care. The centre has 43 en-suite bedrooms and 5 flats situated over two floors. People are admitted to Broadmeadow from a range of settings, including 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. At the time of the inspection there were 38 people living at the service.

We last inspected Broadmeadow in August 2017 when three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices in relation to unsuitable maintenance of the premises, care plans that were not personalised and auditing systems which had not been effective.

At our last inspection, the service was rated ‘Requires Improvement’ overall with effective and caring being rated as Good. At this inspection, improvements had been made and the three breaches of regulations were now met. However, a new breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 was identified and a recommendation was made regarding staff supervision. Therefore, this is the second consecutive time the service has been rated Requires Improvement.

There was a registered manager in post who had been in post since August 2016. 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. Following this inspection, we received some information of concern relating to the submission of statutory notifications. The registered manager had failed to notify CQC of a notifiable event in a timely manner.

At the time of our inspection medicines were observed to be administered safely. Systems were in place for the ordering, obtaining and returning of people’s medicines. Staff had received training in the safe administration of medicines and their competency had been assessed by a member of the management team. Following our inspection, we received some information of concern relating to the safe administration of people’s medicines, this concern was under investigation.

Staff did not always receive the support, supervision and guidance from the management team. The registered manager told us they were aware of the shortfalls in supervision and had planned to resolve this. The registered manager used a variety of methods to ensure the care staff were kept up to date with people’s needs. We have made a recommendation about this.

People felt safe and were protected from the potential risk of harm and abuse. Staff understood their responsibilities for safeguarding people and followed the provider’s policy and procedure. People’s personal belongings were protected from the potential risk of theft. Potential risks to people had been assessed and steps were taken to reduce any risks. The premises were well maintained and equipment had been regularly serviced to ensure it was in good working order.

There were enough staff deployed to keep people safe and meet their needs. Staff were recruited safely following the provider’s policy and procedures. Staff received training to meet people’s needs including their specialist needs.

People’s safety in the event of an emergency had been assessed, with guidance t

The inspection was carried out on 13 June 2017 and was unannounced. Broadmeadow is a large purpose built service. It provides intermediate care, short term respite and dementia care. There are 43 ensuite bedrooms situated in five units over two floors. Two intermediate care units and the Channel suite a dementia unit are located on the ground floor. An older persons unit and five flats for respite care for younger adults are located on the first floor. It can accommodate up to 48 people, providing care and support for 35 older people, five younger adults with a physical disability, and eight adults living with dementia. People in residence at inspection was 29.

The service has a registered manager. A registered manager is a person who is 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.

At the previous inspection in October 2014 we found that the provider was meeting the regulations but recommended that staffing levels at night be reviewed. At this inspection we checked to see if they had taken action to improve staffing levels and found that they had.

People are admitted from a range of settings – acute hospital beds, their own homes and temporary residential care. People requiring rehabilitation are predominantly admitted from hospital and there is a joint assessment process from health and social care staff. The service is designed to prevent further admission to an acute hospital, facilitate a prompt return home and prevent admission to permanent residential care.

The service provides regular respite for some people living with dementia to help enable them to remain at home in the community. People assessed for rehabilitation are supported to regain a level of independence to support a move back home. Other people who are unable to return home stay longer until they are found more suitable long term placements or their home circumstances improve.

Service staff work in partnership with health colleagues from the intermediate care team to provide people with a rounded package of support. Health professionals also visit people on the other units as and when required.

Systems to enable the checking and monitoring of operational aspects of the service that ensure people and others were safe, were not robust. People could be placed at risk because fire risk assessment recommendations had not been completed. The registered manager was unable to confirm that outstanding electrical works dating from 2012 had been implemented and completed. Personal evacuation plans lacked detail to inform staff what level of support people might need in an evacuation. Some day and night staff had not attended fire drills in the last 12 months.

There was a risk assessment framework which was generic, some risks people experienced were not adequately assessed by looking at individual needs and people could be placed at risk of not receiving the right support.

Staff were recruited appropriately but their records were in disorder and information was difficult to find. Medicines were managed safely but the good practice of recording start dates on medicines used, needed to be expanded to include ‘as required’ medicines to improve medicine audit processes and also monitor consistency of administration of these medicines. Care plans lacked individualised detail; important information about some needs was not always located in the same places in care records. This was confusing and could lead to omissions of important information and staff not receiving the information they need to support people appropriately and in accordance with their wishes.

The premises was clean, comfortable and well maintained; there was an award winning environment for people living with dementia located in the Channel

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.

People we spoke with during this inspection told us that they felt they were well cared for and their needs were met. One person told us the care was "wonderful". Another person said they had "nothing but praise" for the way they had been supported during their time at the service. A relative told us the care was "excellent".

We looked at how well the service worked with other professionals and found there was a willingness to cooperate. This was confirmed by a therapist we spoke with who worked closely with the service.

We looked at the measures that were in place to ensure the environment was clean and hygienic. We saw that there were guidelines and information on infection control displayed for staff. Staff had undertaken training on infection control and this was updated regularly. We saw that the kitchen had a five star rating for hygiene.

We spoke with staff who had been working at the service for varying lengths of time concerning the support and training they had received. We found that staff felt they were well supported and had received the training they needed to do their job well.

We asked people about the complaints procedure. People who used the service told us that they felt they were able to raise any concerns they had and that they would be listened to. A relative we spoke with said that they did not feel it would be a problem to raise a concern. Staff showed an awareness of how to help someone if they wished to raise a complaint.

We spoke with four people who used the service and five relatives. People told us that they were treated with respect "All the time" by the staff. Individual choice was respected for example in regard to people being able to have meals in their rooms.

People told us they were involved in planning their own care. One person told us they had their "Care planned reviewed with them and staff were happy to implement changes". People were encouraged to be as independent as possible. One person told us in respect of their care you "Could not ask for better... a first class experience". People told us they felt the staff looked after them well and that their personal property was safe.

People and their relatives had been asked their views of the service in person with staff and through surveys. People and relatives told us they had had no need to raise any issues but felt happy and able to do so with the manager or staff if needed.

People told us staff had talked to them about the care and support they needed when they first came to Broadmeadow. Most people spoken with did know about their care plan (a plan of care outlining how staff will support them), felt they had been involved in reviewing it and that they had signed it in agreement. Others did not due to the level of their mental impairment

People told us they were able to make decisions about their care and day to day lives. Several people spoken with said they were happy with the care given and had no concerns. One lady said on the intermediate care unit said “very good excellent” another said when referring to staff “They are looking after us well here, staff are very nice”. We were unable to speak to other people in other parts of the service due to the level of their mental impairment.