The inspection took place on 9, 12 and 23 March 2018. The first day of our inspection visit was unannounced.

Broomy Hill Nursing Home is a ‘care home’. People in care homes received 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. Broomy Hill Nursing Home accommodates up to 40 people with dementia-related illness and mental health needs. There were 37 people living at the home when we visited.

There was no registered manager in post during our inspection. We met with the manager who had applied to become registered manager of 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 2008 and associated Regulations about how the service is run.

At our last comprehensive inspection of the service on 16 January 2017, we found a breach of Regulation 17 of the Health and Social Care 2008 (Regulated Activities).Regulations 2014. We gave the service an overall rating of Requires Improvement. This breach related to the ineffectiveness of the provider’s quality assurance. The provider sent us an action plan setting out the improvements they intended to make, and we met with them to discuss this further.

At this inspection, we found the provider was still not meeting the requirements of Regulation 17. Their quality assurance systems and procedures had not enabled them to effectively identify and address the shortfalls in quality we identified during our inspection. We also identified a breach of Regulations 12 of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. This related to the provider’s failure to assess and take all reasonable steps to reduce the risks associated with people’s individual care and support needs.

Infection prevention and control measures at the home needed to be improved to more fully protect people and others from the risk of infection. People’s rights under the Mental Capacity Act had not been fully promoted. Staff lacked insight into people’s dietary needs. Care plans were not routinely read by staff and were not always updated in response to people’s changing needs. A more proactive and consistent approach towards advance care planning was needed.

Staff had training in, and understood, their individual responsibility to protect people from abuse, and the provider had procedures in place to ensure any witnessed or suspected abuse was reported to the appropriate external agencies. Staffing levels at the home ensured people’s individual needs could be met safely. The provider completed checks to confirm the suitability of all prospective staff. People received their medicines safely and as prescribed from qualified nurses.

People had support and encouragement to follow a balanced diet, and were involved in choices about what they ate and drank. Any risks associated with people’s eating and drinking were assessed. Staff received training and ongoing support to help them succeed in their roles. They defused difficult situations with skill and insight into people’s individual needs and personalities. Staff and management helped people to access, a range of healthcare services to ensure their health needs were met. The overall design and adaptation of the premises enabled staff to meet the needs of people living with dementia effectively.

Staff adopted a kind and caring approach towards their work. People and their relatives had support to support to participate in decision-making that affected them and to express their views on the service. Staff treated people with dignity and respect.

People received care and support that reflected their individual needs and preferences. People’s relatives were able to contri

We carried out an unannounced comprehensive inspection of this service on 16 January 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to staff training and supervision, and the provider’s quality assurance systems and processes. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements.

Following our inspection on 16 January 2017, we also received concerns in relation to the practice of locking people’s bedroom doors at the home throughout the day and night, and how this was being managed. These doors were fitted with specially designed locks that automatically disengaged when opened from within the bedroom itself. We also looked into these concerns during this focused inspection.

This report only covers our findings in relation to these requirements and concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Broomy Hill Nursing Home on our website at www.cqc.org.uk.

This inspection took place on 20 July 2017 and was unannounced.

Broomy Hill Nursing Home provides accommodation with nursing and personal care to a maximum of 40 people living with dementia and mental health needs. There were 36 people living at the home when we visited.

A registered manager was in post and present during our inspection. 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 provider had not delivered training to support staff in carrying out their duties and responsibilities, in accordance with the their mandatory training requirements.

The provider conducted staff supervisions more frequently, and these were now being monitored more closely by the management team. The provider had commenced staff members’ annual appraisals.

The provider’s quality assurance activities had been developed and a new annual audit planner introduced. However, the provider's quality assurance was not as effective as it needed to be in enabling them to address concerns and shortfalls in quality in a timely manner to drive improvement.

People’s rights under the Mental Capacity Act 2005 had not been fully protected in the context of the decisions taken to lock most people’s bedroom doors throughout the day and night. Concerns raised with the provider in relation to staff being unable to access, and support people to access, bedrooms without unnecessary delay had not been satisfactorily addressed.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 16 and 18 January 2017 and was unannounced.

Broomy Hill Nursing Home provides accommodation with nursing and personal care to a maximum of 40 people with dementia-related illness and mental health needs. There were 35 people living at the home when we visited.

A registered manager was in post and present during our inspection. 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.

At our last inspection on 10 and 12 August 2016, we found breaches of Regulations of the Health and Social Care 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulation 2009. We gave the service an overall rating of requires improvement. These breaches related to the provider's failure to always treat people with dignity and respect, manage people’s medicines safely and notify us of an allegation of abuse involving a person who lived at the home. The provider sent us an action plan setting out the improvements they intended to make.

At this inspection, we found the provider had made some improvements to the service. However, people were still not always treated with dignity and respect. In addition, staff had not received appropriate training, supervision and appraisal. Some staff also still lacked confidence in the registered manager’s ability to act on things brought to their attention. The provider’s quality assurance systems had still not enabled them to address significant shortfalls in the quality of the service.

Staff understood how to recognise and report abuse. The risks associated with people’s care and support needs had been assessed, recorded and plans implemented to manage these. There were sufficient numbers of staff to safely meet people’s needs, although staff deployment could be improved. People’s medicines were managed and administered in a safe manner.

Staff sought people’s consent to care and protected their rights under the Mental Capacity Act 2005 (MCA). Staff supported people to have enough to eat and drink, and to have a balanced diet. People’s day-to-day health needs were met, and staff supported them to access healthcare services.

Staff took a patient, caring and compassionate approach to their work with people. They encouraged people to express their views and be involved in decisions, where possible. People’s care and support was shaped around their individual needs. Staff supported people to spend time doing things they enjoyed and found interesting. People’s relatives knew how to complain about the service, and felt confident their concerns would be appropriately handled. The provider encouraged a positive and open dialogue with people’s relatives. Staff found the management team approachable.

This inspection took place on 10 and 12 August 2016 and was unannounced.

Broomy Hill Nursing Home provides accommodation with nursing and personal care for up to 40 people with dementia-related illness and mental health needs. There were 39 people living at the home when we visited.

A registered manager was in post and present during our inspection. 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.

Working practices at the home needed to be improved to ensure that people received their medicines safely. People were protected by staff that recognised the potential signs of abuse and how to report it. The provider had developed procedures for dealing with any such allegations of abuse, and plans were in place to manage the risks associated with people’s individual care and support needs. The registered manager monitored any incidents and accidents involving people to minimise the risk of reoccurrence. Staffing requirements were assessed and planned, and all new staff underwent appropriate pre-employment checks.

The provider was not always working in accordance with, and respecting people's rights under, the Mental Capacity Act 2005. Staff participated in an ongoing programme of training and received regular one-to-one sessions with the management team. People received the support they needed with eating and drinking, and any associated risks were managed. Staff supported people to maintain their health and sought appropriate professional medical advice and treatment as necessary.

People were not always treated with dignity and respect, and their choice and control over their lives was not always fully supported. Staff knew people’s individual needs well, and supported them to spend time doing things they enjoyed and found interesting. People’s relatives knew how to raise concerns, and felt confident they would be listened to. Not all staff were confident that concerns brought to the attention of the registered manager, about the care and support people received, would be acted upon.

The provider had developed quality assurance systems and checks, however these had not identified significant shortfalls in the service.

Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. We spent time talking to people and observed the support they received. We talked with visiting relatives, a GP and two other visiting professionals.

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

This is a summary of what we found:

Is the service safe?

Systems were in place to monitor and maintain safety. Records showed that regular safety checks and were undertaken. Staff told us that environmental checks were carried out and any maintenance issues identified were dealt with promptly.

The provider had taken all reasonable steps to help protect people from the risk of abuse. The recruitment process was effective and took necessary action to prevent unsuitable people from working with vulnerable adults.

Staff told us they felt they had been given the necessary training and guidance to carry out their role safely. Risks to people had been identified, assessed and kept under review. This helped maintain people's safety.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant staff had been trained to understand when an application should be made and how to submit one. Applications had been made appropriately and proper policies and procedures were in place.

Is the service effective?

Appropriate arrangements were in place to support people with limited mental capacity to make decisions that were in their best interest. Two health and social care professionals told us they had been impressed that a mental capacity assessment and record of best interest decisions had already been completed for a person had only moved in that week.

People's needs were assessed and care and treatment was planned and delivered in line with their individual needs. The care plans seen had been updated regularly and contained a good level of detail including people’s wishes and preferences. Staff had a very good knowledge of people’s support needs. Staff aimed to provide a personalised service and felt they had time to meet people’s needs.

Incidents and accidents were monitored to look for trends across the service and for the individuals as well. The use of bedrails had been stopped and replaced with less restrictive ways of supporting people. The service aimed to reduce people’s anti-psychotic and sedative medicines wherever possible, in liaison with people’s representatives and health professionals.

Staff told us that they felt part of a good team and that they were well supported. Their training needs had been assessed and planned for and their performance monitored.

Is the service caring?

The people who were able to give us their views told us that staff were respectful and caring. They told us that they were happy with the care and treatment provided and they had no complaints. We observed staff treating people with dignity and respect. Interactions with people were supportive and kind. We observed people being given choice and encouragement.

We saw that staff responded quickly to people who called for assistance. When one person’s knee was painful staff took time to go and check when they could have their next dose of painkillers and explain this to the person with reassurances.

The registered manager and several staff went to the funeral of a person who had lived at the home. They had wanted several staff to attend because they knew there was not any family to attend.

We saw many examples during the day of staff seeking people’s consent before they provided them with care and support. Information was given clearly and staff gave people time to digest this and did not rush them.

Is the service responsive?

Visiting professionals told us that the home was successfully supporting people with very complex needs, any concerns had been discussed openly and new people were given time to settle in however challenging their behaviours seemed initially. They had found that requests for medical or psychiatric support were made appropriately. One said, “The care is personalised” and “They think outside the box”.

The environment was attractive and had been decorated to be as helpful as possible for people living with dementia. The registered manager told us they always looking for ideas that would improve the environment and experience for those living in the home.

The home’s vehicle was used to assist relatives to visit their loved ones and to bring people to the home when they used the respite care service. One relative told us this had been a great help to them since they stopped driving.

Improvements had been quickly made after our inspection in February 2014 when shortfalls were found in staff recruitment practices and arrangements for obtaining people’s consent to care and treatment.

Is the service well led?

We saw that the service was being appropriately managed. The provider and registered manager had responded to the shortfalls found at the inspection in February 2014 and had made the improvements needed.

Visiting professionals told us that the home was run well and the staff were pleasant and helpful. They found the clinical lead nurse was very competent and was always well prepared for the many meetings they held. They were always provided with accurate records to assist their reviewing process. The G.P. had no concerns about the nursing care provided.

Staff felt the service was well managed and that their views and ideas were valued. They told us there was enough staff on duty to meet people’s needs and no agency staff were used. One carer said, “We all work together” and “Everyone supported each other when there were incidents and difficult days”.

The registered manager was aware of their duty to report certain incidents to us, such as deaths, and safeguarding alerts to us and the local authority. Any complaints were recorded and monitored by the provider.

The quality of service provided by the home was regularly monitored and surveys were used to seek people’s views.

Because few people living at the home were able to tell us themselves, we spent time observing what life was like at the home. We saw numerous examples of the staff being kind and thoughtful in the way they helped people. We saw that even when they were busy the staff were cheerful and did not rush people. When people became distressed the staff went to help them as soon as they could. The staff we spoke with had a positive attitude to their work. One of the staff told us they liked, “Making a (positive) impact on their lives and making things better”.

The care records contained information about people’s care needs. The staff reviewed and audited these regularly. The staff told us they had the information they needed to provide the correct care to each person and could describe people's needs when we asked. The arrangements for making sure that consent for care and treatment was obtained in line with legislation needed to be improved.

People's medicines were stored securely and managed in a well organised and safe way.

The staff recruitment procedures needed to be improved to make sure that all the required information was obtained for every applicant.

There were arrangements in place for monitoring the quality of the service and obtaining people's views about the care provided. We saw that the service had received generally positive feedback. We saw comments by several relatives and professionals commending the staff team for their care.

During our inspection we spent time in the communal areas of the home so that we could see what life was like there. We saw that staff were respectful and kind when they spoke with people. We spoke by telephone with four relatives. Each of them was positive about the care of their family member. One person told us their relative was, “looked after very well”. Another commented that the manager, “gets staff to go the extra mile” and that the staff were, “always polite, nice and chatty”.

The care records contained information about people’s care needs and showed that the staff arranged the health care people needed. Most of the care practice we saw was safe and considerate. We saw examples of care workers supporting people who were distressed. They did this in a sensitive and patient way. We saw two incidents where staff used an incorrect method to move people. We also saw an incident where a care worker moved a person without speaking to them.

We saw that although staff did their best to attend to people as soon as they could, there were occasions when this was delayed. This appeared to be due to staff sickness on the day of our inspection. Staff told us there were normally more staff on duty. One relative told us there was, “always someone there” when they needed staff to assist their family member.

There was information available for people about how to make a complaint. People told us they would be able to raise anything they weren’t happy with.

People and their families told us they were treated well by the staff at Broomy Hill. Comments included “the staff are so kind and are so lovely” and “we chose the home because of the staff”. One relative commented that their family member was always clean and tidy and appeared to be happy living at the home. People described the staff as “really gentle and kind” and “really nice”. People felt their relatives’ care needs were being met.

Whilst people were happy with the care at the home, not all staff consistently maintained people’s privacy and dignity.

Records did not always reflect the level of care necessary for people’s health, safety and welfare. Care charts and people’s daily records did not always show the support people received. It was therefore not possible to see whether people’s needs were effectively being met.

There was a lack of choice for people at mealtimes, and there was evidence that staff were not always ensuring that people had enough to eat and drink.