The inspection took place on 6 and 7 June 2017 and was unannounced.

Broomfield Lodge provides accommodation and personal care for up to 24 older people and people living with dementia. The service is a large converted property and accommodation is arranged over two floors. A lift is available to assist people to get to the upper floor. The service has 21 bedrooms, seven of the bedrooms have ensuite toilets. There were 20 people living at the service at the time of our inspection.

There was a registered manager working 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 in the Health and Social Care Act and associated Regulations about how the service is run.

We last inspected the service in April 2016. We found shortfalls in the service. The provider had failed to store medicines safely, had not accurately recorded the application of creams and had not checked staff competency regularly to assess that medicines were administered safely. The provider had failed to develop a care plan for each person, which included ways in which the person preferred their care to be provided and how they could maintain their independence.

We asked the provider to provide an action plan to explain how they are going to make improvements to the service. At this inspection we found that improvements had been made.

Each person had a care plan that had been written with the person and their relative, giving details of how they like to be supported with their care. There was detailed guidance for staff to follow to provide consistent and safe care, staff were knowledgeable about people’s preferences and described how they supported people following the guidance in the care plans.

People’s medicines and creams were stored safely. There were accurate records of where and when the creams had been applied. Medicines were stored at the recommended temperature to ensure the medicines remained effective. People received their medicines when they needed them from staff trained and competent in the safe administration of medicines.

People told us they felt safe living at the service. Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. Some risk assessments were not detailed enough to ensure that all staff were providing support in a safe and consistent way. Staff told us how they provided support to people and this was safe and consistent. During the inspection the registered manager completed new detailed risk assessments. We have made a recommendation that risk assessments should include more detail.

Staff completed checks on the environment, to ensure people were safe. Accidents and incidents were recorded and analysed to identify any patterns or trends to mitigate the risk of them happening again.

Staff knew about abuse and knew what to do if they suspected any incident of abuse. Staff were aware of the whistleblowing policy and the ability to take concerns to agencies outside of the service. Staff were confident that any concerns they raised would be investigated to ensure people were kept safe.

People received effective care from staff who had the knowledge and skills to carry out their roles. Staff were knowledgeable and were able to tell us and we observed how they put their training into practice. Staff understood their roles and responsibilities, the management team worked with staff to ensure they were competent in their roles. Staff told us they felt the management team was approachable and supportive.

The registered manager followed the provider’s recruitment policy to make sure that staff were of good character. Staff completed regular training, had one to one meetings and annual appraisals to discuss their personal development.

There were consistent numbers of staff e

This inspection was carried out on 7 and 8 April 2016 and was unannounced.

Broomfield Lodge provides accommodation and personal care for up to 24 older people and people living with dementia. The service is a large converted property and accommodation is arranged over two floors. A lift is available to assist people to get to the upper floor. The service has 21 bedrooms, six of these bedrooms have ensuite toilets. There were 17 people living at the service at the time of our inspection.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. 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.

Staff did not always provide people’s care in the way they preferred. Assessments of people’s needs were not always fully completed and reviews had not identified that the information was not correct. Accurate guidance had not been consistently provided to staff about how to support people in the way they preferred.

Action was taken to identify changes in people’s health, including regular health checks. People were supported to make decisions and choices.

People’s medicines and creams were not always stored safely. There was a risk that medicines would not be effective and creams would be used by people they were not prescribed to. Records were not kept when people received their cream. Checks had not been completed to make sure people had received their prescribed creams when they needed them.

People’s ability to make certain decisions had been assessed. When people could not make a particular decision, staff made decisions in people’s best interests with people who knew them well. The requirements of the Mental Capacity Act 2005 (MCA) had been met.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). Risk to be people had been identified and arrangements were in place to apply to the supervisory body for a DoLS authorisation when necessary.

People were offered a variety of activities that they enjoyed. Possible risks to people had been identified and were managed to keep them as safe as possible, without restricting them.

People told us they liked the food at the service. They were offered a balanced diet that met their individual needs. A range of foods and drinks were on offer to people throughout the day and night to make sure they were hydrated and not hungry at any time.

People were treated with dignity and respect at all times. People and their relatives told us staff were kind and caring. Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager or the local authority safeguarding team. When concerns were raised action had been taken promptly to keep people as safe as possible. Plans were in place to keep people safe in an emergency.

People and their representatives were confident to raise concerns and complaints they had about the service. People were satisfied with the response they received. Systems were in operation to regularly assess the quality of the service. People and their relatives were asked for their feedback about the quality of the service they received.

The registered manager provided leadership to the staff and had oversight of the service. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs. They were motivated and felt supported. Staff told us the registered manager and provider were approachable. Staff were supported to provide good quality care and support. They had completed the training they needed to provide safe and effective care to people. Some staff held recognised

We used a number of different methods to help us understand the experiences of people using the service as the people using the service had complex needs which meant they were not able to tell us their experiences. We observed staff interacting well and communicating effectively with people. We saw people undertaking activities and displaying pleasure when doing them. In our discussions with staff they demonstrated a thorough knowledge of the people living at the service. This was confirmed by our observations and by what we were told by a relative.

Care records showed that people had been supported to make decisions about their care. We saw that people's representatives had been involved in planning care and support. When people’s needs changed, we found that records had been updated to reflect this. We saw that people's needs had been thoroughly assessed and care was provided taking into account people's rights and well-being.

Staff demonstrated a good understanding of how to safeguard people from harm. Training records showed that staff received regular training to update their knowledge on safeguarding and topics relevant to their care role such as dementia awareness.

Medication was correctly stored and administered within guidelines. The clinical room was appropriately organised, and policies were in place to ensure that correct medication administration and disposal was adhered to.

Staff reported feeling fully supported by management and were positive about colleagues.

We used a number of different methods to help us understand the experiences of people using the service. We spent time with people and observed what was happening in the home. We saw people enjoying listening and at times singing with an entertainer who was there on the afternoon of the inspection.

People told us that they had the care and support they needed to remain well and healthy. People said they liked living at the service. We found that where possible people were asked to give consent and were involved in the decisions about the care and support they received. Where this was not possible we found that best interest meetings and mental capacity assessments had taken place.

We found records to show how people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well being.

People told us and records confirmed that medicines were given to people when they needed them in a safe way.

People and their relatives told us that they thought that there were enough staff on duty and they knew what they were doing. Staff listened to people’s requests and responded quickly. People said, “The staff are very helpful and reassuring” and “All the staff are very kind and patient”.

People and their relatives told us they did not have any complaints about the service. They were confident if they did the manager would take action to resolve any issues.

Some of the people at Broomfield Lodge had dementia and therefore not everyone was able to tell us about their experiences. Some people living in the home were unable to verbalise to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

Other people were able to tell us that they had the care and support they needed to remain well and healthy. Everyone we spoke to said good things about the staff like “It’s good here, the staff do whatever they can for you”, “They are very good at night they come quickly if you call them”, “We have a few laughs”.

People said they liked living at the home and they were involved in decisions about their care and support.

They told us that the food was good and that they were happy with their bedrooms. One person said ‘I do like it here. You get what you need but I would like to go out more’.