Broomfield Residential Care is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to accommodate 50 older people some living with dementia and mental health difficulties; at the time of our inspection, there were 30 people living in there.

At our last inspection in May 2017, this service was rated overall as good. We had received information that the service may have deteriorated and decided to undertake a Responsive inspection on 26 and 28 November 2018. At this inspection, we found that the service had deteriorated and has been rated as requires improvement. This is the third time the service has been rated as requires improvement in the last three years.

The first day of the inspection was unannounced.

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.

There is not always sufficient staff deployed to provide care safely in a timely way. People are left waiting for assistance at times. There is limited opportunity for people to follow their interests or take part in meaningful activities which would keep them more active and mentally stimulated.

People’s choices are limited and their preferences are not always considered. Their dignity is not always protected.

The systems in place to monitor the quality of care and effectiveness of the service are not always effective and fail to pick up some of the shortfalls in the quality and standard of care being delivered.

Staff undertake all relevant training but not all staff demonstrate their knowledge and understanding in practice.

Risk assessments are undertaken and plans put in place to mitigate the risk identified. However, the information recorded to mitigate the risk is not always sufficiently detailed to ensure people are cared for safely.

People receive care from staff that know them and are kind and compassionate. The staff are friendly, caring and passionate about the care and support they deliver. People have formed positive therapeutic relationships with staff and are treated as individuals.

Staff understand the need to undertake specific assessments where people lack capacity to consent to their care and/or their day-to-day routines and staff support people in the least restrictive way possible; the policies and systems in place in the service support this practice.

Care plans are in place, which enable staff to provide consistent care and support in line with people’s personal preferences and choices, however this need improving to ensure more detail is captured and kept up to date. End of life wishes are discussed and plans put in place when required.

People are cared for by staff who demonstrate an understanding of each person’s needs. This is evident in the way staff speak to people and engage with them. Relatives speak positively about the care their relative receive and feel they can approach management and staff to discuss any issues or concerns they have.

Staff are appropriately recruited. People receive their prescribed medicines safely. Staff understand their responsibilities to keep people safe from any risk or harm and know how to respond if they have any concerns.

People’s health care and nutritional needs are carefully considered and relevant health care professionals are appropriately involved in people’s care. Family and friends are welcome at any time and encouraged to take part in any social events at the home.

People know how to raise a concern or make a complaint and ther

This inspection took place on 04 May 017 and was unannounced.

Broomfield Residential Care is located in the village of Olney in Buckinghamshire and is registered to provide accommodation and personal care. They are registered for up to 50 older people who may also be living with conditions such as dementia. On the day of our inspection there were 37 people living at the service.

The service has a registered manager. 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.

People felt safe. Staff had been provided with training to enable them to recognise signs and symptoms of abuse and they knew how to report any concerns. People had risk assessments in place to enable them to maintain their independence and keep them safe. Adequate staff with the appropriate skill mix were available to support people with their needs. Effective recruitment procedures were in place to ensure suitable staff were employed to work with people using the service. Systems were in place to ensure that medicines were managed safely. This ensured that people received their medicines at the prescribed times.

Staff received appropriate training, supervision and support to enable them to carry out their roles and responsibilities effectively. People’s consent to care and treatment was sought in line with the principles of the Mental Capacity Act (MCA) 2005 legislation.

People were able to make choices about the food and drink they had and to maintain a healthy and balanced diet. Staff supported people to access a variety of health professionals including the dentist, optician, chiropodist, dietician and the speech and language therapist.

People and their relatives commented positively about the standard of the care provided. Staff provided care and support in a meaningful manner; and knew about people’s preferences and personal histories. People’s views were listened to and they were actively encouraged to be involved in their care and support. Staff ensured that people’s privacy and dignity was upheld. Any information about people was respected and treated confidentially.

People’s needs were assessed before coming to live at the service and the care plans reflected how their needs were to be met. People were supported to take part in activities and there was an activities programme in place. There was a complaints procedure in place to enable people to raise complaints.

There were effective management and leadership arrangements in place. Systems were also in place to monitor the quality of the service provided. Action plans were in place and were updated after checks and audits, to help further develop the service. The registered manager also submitted statutory notifications to the CQC when required.

Broomfield Residential Care is located in the village of Olney in Buckinghamshire and is registered to provide accommodation and personal care. They are registered for up to 50 older people who may also be living with conditions such as dementia. On the day of our inspection there were 37 people living at the service.

We carried out an unannounced comprehensive inspection of this service on 10 August 2016 and identified six breaches of legal requirements. We issued the provider with a warning notice for two of these breaches and they wrote to us with an action plan explaining how they would meet the other requirements. On 13 December 2016, we carried out a focused inspection to see whether the provider had followed their improvement plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Broomfield Residential Care on our website at www.cqc.org.uk.

During the inspection on 10 August 2016, we found that risks to people were not always well managed. Risk assessments were not always specific and did not contain guidance for staff regarding how they could reduce risks. Risk monitoring was carried out, such as regularly weighing people, however; there was a lack of action taken in response to changes in the levels of risk to people. We also found that areas of the service were not always clean and free from the risks associated with infection control. There were not effective cleaning schedules or logs in place to ensure cleaning was carried out as required.

We also found that people did not always receive sufficient food and hydration to meet their needs. We saw that where people had lost weight, the service had not always taken action to manage that weight loss or to refer people to appropriate healthcare professionals. In addition, people did not always receive person-centred care, which was tailored to meet their individual needs and preferences. Care plans did not always have specific information about how people wanted their care to be provided and there was a lack of stimulation and activities to keep people occupied.

Quality assurance procedures at the service were not effective and did not help the registered manager or provider to have oversight over the care and support being provided. The systems which were in place had failed to highlight areas for development, which meant improvements were not being driven at the service. The registered manager and provider had also failed to send statutory notifications to the Care Quality Commission (CQC) for some incidents of abuse or suspected abuse.

We asked the provider to take action in response to our concerns around risk management and quality assurance by 31 October 2016. The provider sent us an action plan to tell us how they would meet our other concerns and stated that they would be meeting these legal requirements by 31 October 2016. During this inspection we returned to see if the service had made the improvements we asked for and they stated in their action plan. We found that the provider was now meeting these regulations.

The service had a registered manager. 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.

Improvements had been made to the systems in place for assessing and managing risks to people. Risk assessments were more comprehensive and contained specific information and guidance for staff, which helped them manage risk. Where risks had been identified, such as in relation to weight loss, action was now taken promptly to mitigate that risk and to try to help people's conditions improve. Impr

We carried out an unannounced inspection of this service on 10 August 2016. A comprehensive inspection was carried out previously on 15 June 2015 and a rating of 'Good' was given overall.

Broomfield Residential Care is registered to provide accommodation for people who require personal care for up to 50 older people who may also be living with dementia. On the day of our inspection there were 37 people living at the service.

Prior to this inspection we received some information of concern about the care that people were receiving at the service. We were told that there were concerns around infection control practices at the service and that some areas were not always kept clean. We were also told people did not always receive personalised care which was in accordance with their own needs and wishes and that activities were not sufficient to provide people with enough stimulation. We carried out this comprehensive inspection to check these areas and to inspect the whole of the service.

The service had a registered manager. 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 not always taken steps to manage risks to people's health and well-being. There was on-going monitoring of key information regarding people's health however; action was not always taken in response to changes. Risk assessments were also in place in people's care plans, but they failed to reflect these changing conditions, or provide staff members with information about what they could do to reduce the impact of those risks.

There were areas of the service which had not been cleaned effectively. There was not a system in place to ensure that staff members knew what cleaning should be conducted and when. In addition, there were no checks carried out to ensure that cleaning had taken place and to identify areas where additional cleaning was required.

People were not supported to have a suitably nutritious diet to help them maintain good health. Some people at the service had lost weight over a number of months and action had not been taken to prevent further weight loss. Food offered to these people had not changed to help them gain weight and referrals to healthcare professionals had not taken place. The provider did not have systems in place to ensure that people received the care and support that they needed, and that their health and well-being were promoted.

Care was not always person-centred. Care plans were in place however they were not always reflective of people's current needs and wishes. They were reviewed on a regular basis however; changes were not made to them to ensure they were updated as people's needs changed. People were not provided with regular activities or supported to engage in their hobbies or interests to keep them stimulated. Staffing levels were sufficient to meet people's care needs, but not to ensure that they had the opportunity to engage in activities or to spend time talking and relaxing with members of staff.

Quality assurance processes were carried out however; they were not effective in monitoring the service and identify areas where improvements were required. There were no action plans in place to demonstrate that action was being taken to develop the service.

Staff members did not always feel they received formal support from the service. They received regular supervision sessions but did not feel they were able to raise issues and explore their development needs. Training courses were mainly carried out by distance learning courses which some staff did not feel provided them with the same opportunity to learn as other training methods.

People felt safe living at the service. Staff members were trained in recognis

This inspection took place on 15 June 2015.

Broomfield Residential Care is a residential care home which caters for older people and specialises in providing support for people with dementia. The service can support up to 40 people and at the time of our inspection there were 35 people living there.

The service had a registered manager. 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 were protected from harm or abuse by staff that knew and understood safeguarding adults principles.

Risks to people’s safety had been assessed, and plans put in place to minimise risk levels, whilst still promoting people’s choices and independence.

There were sufficient numbers of staff to meet people’s needs. Robust recruitment processes had been followed to ensure that staff were suitable to work with people.

Systems were in place for the safe administration, storage and recording of medicines.

Staff had been appropriately trained to perform their roles, and receieved regular supervisions with the registered manager.

People were encouraged to make choices for themselves and consent to care was sought. The principles of the Mental Capacity Act 2005 had been followed, as well as the Deprivation of Liberty Safeguards when people couldn’t consent to their care.

People had sufficient food and drink to maintain a healthy, balanced diet and had choices regarding what they wanted to eat and drink.

Staff supported people to access health professionals, if and when they needed to see them.

Positive relationships had been formed between people and staff. Staff displayed kindness and compassion when interacting with people.

People were supported as much as possible to be involved in their care.

Dignity and privacy were promoted by staff and people’s rights were protected.

People received person-centred care which was based on their individual strengths, interests and needs.

There was an effective feedback and complaints procedure in place.

The service had an open, positive and forward thinking culture.

There were internal quality control systems in place to monitor quality and safety and to drive improvements.

We considered all the evidence we had gathered under the outcomes we inspected during our inspection at Broomfield Residential Care Home. 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 to people’s needs?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

Because of people's complex needs we were unable to speak with all of the people who used the service, however we observed that everyone appeared happy. We noted they were comfortable in the presence of any of the staff, including the registered manager and the provider.

Person centred care plans and individual risk assessments were being improved and updated to electronic versions. The new system would support staff to ensure they included specific detail within care records. The intention was that staff would be clearly guided to deliver consistent care and ensure that people were protected from harm.

We found that there was a robust system in place to make sure that the manager and staff learnt from events, including accidents and incidents, health and safety issues, complaints and concerns. This meant that the risk of harm to people was reduced. In addition, the service was able to evidence its plans for future improvements.

Is the service effective?

We saw that people were supported, within the confines of their health and medical condition, to be involved in their care planning. For example, where possible they had stated their preferences, particularly in relation to their food likes and the gender of the staff providing their care.

Staff we spoke with had a good understanding of people’s needs and knew how they preferred to be supported. This meant people were supported appropriately in relation to their needs

We observed staff responded promptly to people's needs and call bells were not left unanswered. We saw that care plans had been updated when people's needs had changed, and referrals had been made to other health and social care professionals when needed to ensure best care.

Is the service caring?

During our visit we observed positive interactions between the staff and the people who used the service. People were supported and spoken to in a kindly manner by all of the staff. One person said, “Everyone is nice, they look after us.” We saw a number of cards from the relatives of people using the service that thanked the staff for their care and attention. A relative told us that they felt welcome in the home at any time.

The staff we spoke with had good knowledge about people’s medical conditions and needs and would seek advice and support appropriately to ensure people's well-being.

Is the service responsive to people’s needs?

Staff confirmed they had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We saw that people were able to access most areas of the home, including the garden.

We observed that staff responded promptly to people's needs and that call bells were close at hand for those people that spent time in bed or their bedrooms. People were supported as necessary in a considerate manner, for example during mealtimes.

There was sufficient staff on duty at the time of our inspection, although we discussed with the provider and the manager the deployment of these staff, particularly over lunchtime which was a busy period of the day.

Is the service well-led?

The service had a registered manager. Staff told us the manager was approachable and supportive.

Documentation confirmed that the manager supported the staff to learn from incidents.

We saw that the provider had effective systems to assess and monitor the quality of the service they provided and took account of these to improve the service.

Some people were unable to speak with us because their dementia had impaired their ability to communicate verbally. We used a number of different methods to help us understand the experiences of people using the service, including observation, talking with people who were able to respond, and talking with visitors. One visitor said, “As far as I am concerned all the staff do a good job.” They said their relative was “well looked after”.

We saw that the new provider has already made improvements to the premises and we were told there were plans to do much more. For example, some bedrooms had been completely re-decorated and had new carpets fitted. One person said, “My room has just been painted. It has really cheered me up. I am delighted.” We also saw that the central courtyard had been made attractive with flowering plants and outdoor furniture.

We found that people's privacy, dignity and independence was respected and that people were involved as much as possible in decisions about their care. We found that people's needs had been assessed and care plans to meet their needs were in place and were being used effectively by the care workers.

We found that ‘Broomfield’ was appropriately managed and that the staff were friendly, caring, and provided a safe and effective service that met people’s needs.

We spoke with three people during our visit to Broomfield Residential Care; one person said “I am pleased to be living here, it’s much better than the place I was living before”. Two other people also told us that they were comfortable living at Broomfield Residential Care. One person told us that they were supported to maintain their faith by the arrangements that were in place for visiting clergy to visit the home.

All of the people we spoke with told us they were comfortable living at Broomfield Residential Care and the staff were nice to them. They told us that they felt safe and knew how to raise any concerns should they need to do so. People told us they were well looked after by the staff who worked at Broomfield Residential Care House and they thought that the staff had the right skills to care for them appropriately.

A visiting relative told us that they were confident that their relative was well looked after by the staff at Broomfield Residential Care. They said “the staff are very good, we are always kept informed about our relatives well being”.