Broxbourne House

Broxbourne House is a residential care home providing personal care for older people, some of whom were living with dementia. Broxbourne House is registered to accommodate 20 people, at the time of the inspection 19 people lived at the service.

People's experience of using this service and what we found

People were happy living at Broxbourne House. They told us staff were kind towards them and knew their needs well. People were encouraged to make their own choices and retain their independence and people's care plans were individualised and person centred.

People felt safe living at Broxbourne House and where risks to people had been identified there was guidance in place for staff. Staff were able to tell us how they kept people safe and had a good knowledge of how to identify and report a potential safeguarding concern.

People lived in an environment that was checked for its safety and suitable for their needs. The environment was spacious and well laid out and was kept clean and tidy by a team of housekeeping staff.

People were cared for by a sufficient number of staff who had been trained and demonstrated competence in their roles. Staff received the support they required through continual learning and development and regular supervision with their line manager.

The manager was involved in initiatives to help assist with the pre-assessment stage for people. Appropriately trained staff safely administered medicines and people received the medicines they required in line with their prescription.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and staff said the service was well led and they felt their opinions were sought and listened to. The registered manager worked alongside the staff and was very visible, they knew people well and focused on delivering person centred care.

The registered manager and staff worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people, their relatives, and professionals and staffs views into account through surveys. There were effective systems in place to monitor the quality and safety of the service and any learning was identified and acted on. Staff enjoyed working at the home and said they received good support from the registered manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 24 February 2021).

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Why we inspected

This focused inspection was prompted by a review of the information we held about this service. We only inspected the key questions, safe, effective and well-led. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Broxbourne House is a residential care home providing accommodation and personal care for 16 people at the time of the inspection.

Broxbourne House accommodates people in one building and communal areas are on the ground floor. Accommodation is on the ground and the first floor.

People’s experience of using this service and what we found

Risks were assessed and managed to keep people safe. Medicines were safely managed. Safe recruitment and induction processes helped ensure suitable staff worked in the home. There were enough staff for people to be supported, and where COVID-19 had affected staff attendance, there was use of consistent agency staff. Support for staff through training and supervision was in place. Infection prevention and control measures were being managed appropriately and the provider had taken action in line with advice of the local infection, prevention and control teams. Safeguarding procedures were followed and staff understood their responsibility to report any concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider ensured people’s human rights were respected and their dignity in their personal care routines was maintained.

Since the previous inspection in October 2020, there had been a further change to how the service was being led and managed. The registered manager had left and the provider had recruited a new manager for the role, although they were not yet in post. There was an interim care manager in post, supported by the provider. Quality assurance systems were in place, although some audits were not fully up to date. The provider had been managing the service during an outbreak of COVID-19 and so had had to prioritise the audits to complete, such as for health and safety.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 14 November 2020). At this inspection we found some further improvements had been made and although the rating was Requires Improvement, the service was continuing to develop their systems to ensure improvements were embedded.

Why we inspected

We undertook this inspection to follow up on a number of specific concerns which we had received about people’s safe care and treatment and the management of the home. A decision was made for us to inspect and examine those risks.

We inspected and did not find any evidence to support the concerns raised.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care homes even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Broxbourne House is a residential care home providing accommodation and personal care for 18 people at the time of the inspection.

Broxbourne House accommodates people in one building and communal areas are on the ground floor. Accommodation is on the ground and the first floor.

People’s experience of using this service and what we found

Systems to assess and manage risks had improved since the last inspection and people were safe. Medicines were safely managed overall. Recruitment and induction processes were in place to help ensure staff were safely in post. Staffing was organised so that people received appropriate support and a programme of staff supervision and training was being embedded so staff were able to support people’s needs. Infection prevention and control measures were in place although some aspects needed to be more robust; the registered manager took immediate action to address this on the day of the inspection visit.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider had taken steps to address issues raised at the last inspection in order to ensure people’s human rights were respected and their dignity in their personal care routines was maintained. People were individually supported to receive care at their preferred times and their daily routines were more personalised to their own needs. Staff were aware of people’s individual communication needs and respected their wishes and preferences. People’s mental capacity and decisions made in their best interests were mostly well recorded, although this needed to be more consistent.

Staff roles and responsibilities were more clearly defined and staff felt supported. Staff worked well together and were kind, patient and caring with the people they supported. People were treated with respect and their independence was encouraged. Staff knew the people they supported and how they liked to be cared for. Feedback from relatives about staff’s caring manner and approach was very positive.

Planned activities were in place for people and the activities coordinator enthusiastically encouraged people to take part. Some activities needed to be more specific to people’s interests and this was an area being further considered for development. We made a recommendation to improve activities through a more person-centred approach. There was work in progress to ensure care records were fully reflective of people’s needs. There had been very few complaints since the last inspection and these had been responded to appropriately. People’s relatives were confident the registered manager and the provider would deal with any matters of concern without delay.

Changes had been made in how the service was being led and managed. The registered manager was developing ways to improve the culture and communication in the home through involvement of the staff team. Staff reported improvements in the quality of the service. Systems and processes with which to monitor the quality of the provision were beginning to be established and embedded. Improvements had taken place in some key areas, such as redecoration and the replacement of floor coverings, mattress bases, bedding and curtains.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was inadequate (published 10 January 2020) and there were multiple breaches of regulation across all domains. The service has been in Special Measures since January 2020. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care homes even if no concerns of risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Broxbourne House is a residential care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection.

Broxbourne House accommodates people in one building. Communal areas are situated on the ground floor. Accommodation is provided on the ground and first floor. At the time of the inspection 21 people were using the service.

People’s experience of using this service and what we found

People were not safe. Risks to individuals were not assessed and appropriately managed. Medicines were not managed safely. There were insufficient staff with the appropriate skills and knowledge to meet people’s needs and keep them safe. Recruitment practices were not robust and did not ensure staff were suitable to work at Broxbourne House. Lessons were not learned when things went wrong.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. New staff did not receive appropriate training which meant they were not equipped with the relevant knowledge and skills. People's experience at meal times varied. People were generally complimentary about the food although some felt there was limited choice. Systems were in place to support people with their health needs. The design of the building meant people had limited space to use. The environment was not decorated to a good standard.

People were not treated with respect and their privacy and dignity was not maintained. Most people did not have their own toiletries and there were no towels, wipes or cloths in people’s rooms. People were often shaved and changed into their nightwear in the bathroom or shower room rather than their own bedroom. Towels, face cloths, duvet covers, pillowcases and sheets were all piled in a cupboard in a bathroom. These were worn, discoloured and some were torn although were replaced when we raised a concern with the registered manager. Some individual staff showed kindness and compassion. Feedback about staff and the care people received was mostly positive.

People did not receive person-centred care because daily routines were task orientated and determined by staff with little choice being offered to people. People were up early, went to bed early and their meals were served early. People's care needs were not identified, recorded, and highlighted in care plans. People sat for long periods with no stimulation and activities were not planned. People were supported to maintain relationships with family and friends; visitors told us they were welcomed. The provider had a system for dealing with complaints and concerns. A concerns record showed when issues were raised they were dealt with appropriately. Action was taken to investigate and resolve the concern.

The provider's quality management systems were not effective and did not identify areas where the service had to improve. The provider and registered manager did not demonstrate they understood their responsibilities and accountability. People who used the service, relatives and staff provided consistent positive feedback about the registered manager and provider. A health professional told us always had opportunity to speak with the registered manager.

The provider sent an action plan after the inspection which showed they were addressing concerns raised by CQC.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 24 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staffing and staff training, person-centred care, treating people with dignity and respect, assessing and managing risks to individuals, management of medicines, recruitment of staff, supporting people around consenting to care, governance, safeguarding people from abuse and failure to notify CQC about significant events.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We referred our concerns to the local safeguarding authority and asked the provider to send us further evidence of improvements. We will meet with the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Broxbourne House is a care home providing accommodation for 21 older people, some of which were living with dementia. It is situated in Wakefield.

The service had a registered manager in post at the time of 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 and associated Regulations about how the service is run.

People who used the service, who we spoke with, told us they were happy with how care and support was provided at the home. They spoke positively about the staff and the way the home was managed.

We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety.

At the time of the inspection there was sufficient staff on duty to meet people’s needs. Relatives we spoke with confirmed when they visited there were sufficient staff on duty. There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. Staff had received a structured induction into how the home operated, and their job role, at the beginning of their employment. They had access to a varied training programme that met the needs of the people using the service.

Systems were in place to make sure people received their medications safely, which included key staff receiving medication training and regular audits of the system.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People had access to activities and stimulation and this was promoted to ensure people achieved a good sense of well-being.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. However, best interest decision processes were being improved at the time of our inspection.

People’s individualised diets were being met. We received positive comments from people we spoke with about the quality of the food.

People were treated with respect .People and their relatives told us staff were kind and very caring. Staff demonstrated a good awareness of how they respected people’s preferences and ensured their privacy and dignity was maintained. We saw staff took account of people’s individual needs and preferences while supporting them.

There was a system in place to tell people how to make a complaint and how it would be managed. We saw the complaints policy was easily available to people using and visiting the service. The service actively sought the views of people living at the service to continuously improve the service.

There were systems in place to monitor and improve the quality of the service provided. The systems identified any areas for improvement and these were actioned by the registered manager and the provider.

We observed that staff were polite and interacted well with people. Staff understood the needs of people who lived in the home and supported them in line with guidance in their care plans.

There was a relaxed and comfortable atmosphere within the home and the staff we spoke to understood how to support people, assist them to make choices and maintain as much independence as possible.

In order to protect the people who used the service, we saw that the home carried out a rigorous staff recruitment process. We saw that staff were knowledgeable about peoples needs and treated people as individuals and delivered individual personal care.

People were safeguarded because staff were trained and there were appropriate and robust procedures in place.

People knew who to talk to if they had any concerns about the service and were confident that they would be speedily dealt with.

Relatives we spoke with were unanimous in their praise of the staff and the service they delivered.