All inspections: Broadoak Manor Care Home

This was an unannounced inspection, carried out on 06 May 2015.

Broadoak Manor is situated in a residential area of St Helens with access to local buses. There are four units on the one site providing care and support to people. The service is owned by BUPA who provide a variety of health and social care services throughout the country.

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 2008 and associated Regulations about how the service is run.

At the time of our inspection there were 97 people living at the service.

We carried out an inspection of Broadoak Manor in August 2014 and found that the service was not meeting the regulations we inspected. We took action against the provider which included setting a timescale to make improvements in relation to three regulations. We gave compliance actions in relation to two other regulations.

We carried out a further inspection in December 2014 to check on the progress in relation to the regulations we set timescales for and found they had been met. During this inspection we followed up on the compliance actions we gave the provider in August 2014 and found they had been met.

People who used the service felt safe. Staff had received safeguarding training and had access to safeguarding procedures. Staff knew about the procedures in place to protect people from the risk of harm and they knew how to recognise and respond to abuse correctly. The correct procedures had been followed when abuse was suspected or occurred.

People’s care and support needs were assessed and planned for. Regular reviews involving people who used the service and significant others ensured staff had all the information they needed to meet people’s current and changing needs. People’s care records accurately reflected their care and support needs and the care and support they had received.

People’s needs were met by sufficient numbers of staff. Recruitment procedures were safe and staff had received ongoing training and support to ensure they carried out their role effectively.

Medicines were managed safely and processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw that there were policies and procedures in relation to the MCA and DoLS to ensure that people who could make decisions for themselves were protected. Where people lacked the capacity to make decisions about something, best interest meetings were held and documented in people’s care records.

People were offered a varied and healthy diet and people told us they had enough to eat and drink. People received the assistance they needed at meal times and those who were at risk of poor nourishment were closely monitored.

Staff were kind, caring and patient in their approach. Staff knew people well and formed good relationships with them and their family members.

The provider supported and encouraged learning and the staff team had the required skills and knowledge to care for the diverse and complex needs of the people who used the service.

People’s interests and hobbies were recorded and they were offered a range of indoor activities. However people commented that there had not been given the opportunity to access the community and it was something they would like to do.

People were made aware of how to make a complaint if required and complaints were listened to and acted upon in a timely way.

People described the manager as supportive and approachable and they felt that the service was well managed. There were systems in place to regularly check the quality of the service provided and to ensure improvements to the service were made.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found.

Is the service safe?

The service had four separate units (Havanagh House, Ravenhead House, Stapley House and Ashton House), which could accommodate 30 people in each unit. The inspection took place over two days and included two inspectors on the first day. We carried out a tour of the premises and saw that in some areas of the environment previously identified as unsafe had improved. We noticed significant improvements in the environment on Havanagh House were adaptations had taken place to the environment which had reduced the noise levels and created a calmer atmosphere.

We saw that some people were not receiving safe or appropriate care and treatment that meet their needs. We saw examples were people were not receiving the care outlined in their care plans. We also saw that peoples medical needs were not always appropriately meet.

We gave the service information on the first day of the inspection that indicated potential neglect of an individual regarding a significant weight loss. The safeguarding was not reported to the social services safeguarding unit for four days by the service. The information given to social services was not reflective of the evidence found and feedback to the manager at the inspection.

Is the service effective?

Although training was available there were gaps in staff training that had not been recognised or responded too. The training that had been provided was not sufficient to enable staff to meet people's assessed needs.

Basic training in dementia care and more complex training in dealing with challenging behaviour was not widely in place or available for all staff.

The supervision of staff in order to make sure that they developed and maintained their skills was not consistently being carried out.

Compliance actions had been set in relation to training at a previous inspection. The service has remained not compliant or training at this inspection and as a result the commission has initiated further action.

Is the service caring?

Our observations of staff showed that staff interaction with people living in the home was appropriate. We used a short observation framework inspection (SOFI). SOFI is a tool designed to measure the quality of staff interactions with people. The majority of staff were polite and caring but communication and interaction was in the majority neutral.

On both days of our inspection we saw that the needs of people were not always being met. We saw that staff did support people in a caring manner and maintained their dignity. Staff were respectful, supportive and encouraging.

At our previous inspection the service was not compliant with health and welfare. We issued a warning notice to ensure that improvements were made. . At this inspection we found that improvements to the care that people who lived in the home received had not improved, further action is being considered.

Is the service responsive?

We saw that people's care needs had been appropriately assessed before they went to live at Broadoak Manor. We found that not all reviews of people's care plans had taken place on a regular basis to make sure that their care needs were appropriately recognised and suitable care was delivered.

We found that records were not always accurate or up to date. This potentially placed people living in the service at risk of receiving inappropriate or unsafe care.

Is the service well-led?

Broadoak Manor had a manager registered with CQC. We saw that the provider had systems in place for assessing and monitoring the quality of service and identifying risks. However, the systems had not been effective in identifying and managing the risks to people living in the home.

Compliance actions had been set in a number of the outcomes that we assessed at the previous inspection. Whilst improvements were noted these were insufficient to increase the quality of the service and protect people living in the home from harm. We are considering taking further action due to the on-going concerns with this service. The provider must tell us how they plan to improve in the areas of non-compliance that has been identified.

We considered our inspection findings to answer questions we always ask.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection of Broadoak Manor Nursing Home, speaking with people who used the service, the staff supporting people and from looking at various records.

Is the service safe?

The service was safe

Some of the people living Broadoak Manor Nursing Home had complex needs which meant they were not able to tell us their experiences.

We saw members of staff positively interacting with people who lived in the home. People told us, 'I feel safe living here' and 'I am not neglected and the staff talk to me all the time.'

In discussion and in observation, we saw that people were relaxed and at ease. One example was; A person said they felt cold at the dining table they was asked if they wanted to move they said no but staff got the person a cardigan to help them feel warmer.

Is the service effective?

The service was effective

We spoke with the members of staff who were on duty throughout the day and they all demonstrated they had a clear understanding of people's needs and how to meet them.

We found that people's health and care needs had been appropriately assessed, with people's care plans being detailed and the newly reviewed care plans being more person centred and individualised.

Is the service caring?

The service was caring

During our inspection we observed that members of staff were attentive, caring and

enthusiastic about meeting the needs of people who lived in the service. We saw

people positively responding to members of staff, which showed that a good rapport

existed between them.

Throughout our inspection we saw that people were treated with dignity and respect by the staff. One person commented, 'The staff are very respectful.' A member of staff told us, 'We look at each individual care plan and we have a good relationship with the families.' A relative of one person who lived in the service told us, 'A member of staff came in gave my aunt a kiss and held her hand and reassured her,'

Is the service responsive?

The service was responsive.

During our inspection we saw written evidence that highlighted when any issues had been identified; the service had responded and addressed them.

In reviewing people's care plans we saw that assessment reviews had taken place, with appropriate changes made to help ensure that people's needs were met.

We saw members of staff responding to people's requests in a prompt, skilled and

knowledgeable way.

Is the service well-led?

The service had a manager that has applied to be registered with CQC. The service had quality assurance monitoring processes in place.

Staff comments included, "Things have improved a lot recently'.

We saw documented evidence that staff team meetings had been taking place.

We looked at the audits to monitor the quality of service delivery and saw that several audit records were in place including medication audits, staff training and monitoring of people's needs. We were informed by the local authority's contract monitoring unit that they had seen some positive changes within the service.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found.

Is the service safe?

The service had four separate units (Havanagh House, Ravenhead House, Stapely House and Ashton House), which could accommodate 30 people in each unit. We carried out a tour of the premises and saw that in some areas it was unsafe. We concentrated mainly on Havanagh House, which we observed was noisy, chaotic and unsafe. In Havanagh House we found two storerooms, which should have been locked (fire doors) to be unlocked.

The outside garden area of Havanagh House had paving flags which were uneven and potentially hazardous, particularly for anyone with a mobility problem.

The door step from the lounge area in each house was seen to be a potential trip hazard, particularly for anyone who had a mobility problem.

Some equipment (wheelchairs) at the home had not been well maintained and serviced regularly or stored correctly.

We saw that some people were not receiving safe or appropriate care and treatment.

We found that medicines were well managed.

Is the service effective?

Although there were training records to show that staff had received training, in observation of the care delivery and in discussion with some staff it was clear that the training that had been provided was not sufficient to enable staff to meet people's needs.

Staff had received training in dementia care but we saw people with complex, challenging dementia care needs and staff having little understanding of how to provide the appropriate care and support to meet those needs.

In discussion with staff, some were uncertain if they had received training in dementia and in respect and dignity, others confirmed they had received dementia training, however, we saw people being cared for in a manner that did not protect their dignity or promoted their rights and choices.

The supervision of staff in order to make sure that they developed and maintained their skills was not consistently done.

Compliance actions have been set in relation to training. The provider must tell us how they plan to improve and how they are going to assess the competency of those who receive the training, thereby ensuring that people's needs will be satisfactorily and appropriately met.

Is the service caring?

On both days of our inspection in Havanagh House, we saw that many service users were agitated and disorientated. We saw that the needs of people were not always being met. The practice of encouraging service users to congregate in the noisy central communal area resulted in service users being more disorientated because of the constant distractions. The staff were kind, caring and doing their best. However, in observation it was clear that there was a lack of knowledge and understanding of how to care and support people with advanced dementia care needs.

In the other three Houses, we saw staff interacting and involving people. The people, who lived in these other houses, did not have the same advanced dementia care needs as the people who lived in Havanagh House.

Is the service responsive?

We saw that people's care needs had been appropriately assessed before they went to live at Broadoak Manor. We found that reviews of people's care plans had taken place on a regular basis.

We found that the repositioning record charts for one person had not been correctly completed. This potentially placed the person at risk of receiving inappropriate or unsafe care.

Is the service well-led?

Three of the four units/houses situated at Broadoak Manor were observed to be well-managed and organised. However, as already mentioned Havanagh House was found not to be in keeping with the calm and pleasant atmosphere and environment needed to meet the needs of people with advanced dementia.

We saw that the provider had systems in place for assessing and monitoring the quality of service and identifying risks. However, the systems had not been effective in identifying and managing the risks to people living in Havanagh House.

Compliance actions have been set in a number of the outcomes that we assessed. We are taking further enforcement action due to the ongoing non 'compliance with this service. The provider must tell us how they plan to improve in the areas of non-compliance that has been identified.

We looked at how the service assisted people to receive appropriate care of their choosing.

Our overall observations showed that staff presented with a caring, supportive attitude and were able to speak with empathy about the people they supported. However consistent meaningful communication between staff and people who lived in the home was not always in place.

We found evidence that records about people's care needs and how to meet their personal needs were not up to date. Care records did not always provide staff with clear instructions as to how to meet people's needs and maintain their rights. The acting manager had recognised, through the auditing systems, the need to improve their records and they were taking action to update records and support staff to complete them correctly.

Since the last of 30 November 2012 there had been a significant number of safeguarding concerns reported both to CQC and the Local Authority. The acting manager had recognised that further staff development was needed in this area. The provider had utilised their quality monitoring arrangements to look and plan what staff development was needed.

The auditing systems (checks on quality) had identified other areas for improvement including medicine management, care planning, the monitoring of incidents and accidents.

We spoke with twelve people who lived in the home about their experiences. They told us they were 'happy' living in the home and felt 'safe' living there. They told us they found the staff 'helpful' and they did not have to wait long to be attended to.

We spoke with 13 people at the home and they were able to tell us what it was like to live there and how the staff provided the care and support they needed. All the people we spoke with told us they were happy living at the home. Their comments included, "Everything is very good" and " They look after you well here."

People spoken with confirmed they were encouraged to express their views openly. They informed us they had been asked about their care and treatment and that they understood and consented to it. People also told us had been informed about any changes made to the care they received. We saw evidence of a number of care documents and these recorded good detail about people's needs and how the staff provided care and support to them safely.

A relative informed us the staff were polite and caring. They also told us they were involved with care decisions for their family member and they described the staff as "Brilliant."

We did not ask people directly about staff training however people told us the staff were kind and considerate when caring for them. People told us they felt comfortable and at ease with the staff. A person commented on the good communication with the staff and they said they were able to talk freely about the home.

Systems were in place to monitor the home to ensure people benefited from a well managed safe service.

For the purposes of this visit, we were accompanied by an expert by experience. The expert provides a lay person's point of view about the quality of the care and support provided.The expert looked at outcome areas which we did not routinely look at during the visit and was able through observations and discussions with families and residents come up with a view. The conclusions made included: 'The residents which I saw and spoke to appeared clean, well dressed and cared for.

There were designated smoking areas for residents, which appeared to be rarely used.

There displays advertising activities, but I did not see any during my visit.

Spiritual needs appear to be addressed by visits from local clergy and laity.

There also visits by a hairdresser and chiropodist, there are plans for a barber to attend for the male residents'

'I had lunch with some of the residents; this is a light meal, with breakfast and the evening meal being more substantial.

There were three choices of salad, soup & sandwiches or pasty, peas & gravy, followed by a choice of two cold desserts, and then we offered a cup of tea. I had the soup which was tepid.

Most residents sat at tables which were laid with cloths and cutlery; there was juice and tumblers available.

I saw evidence of residents being helped with feeding, but one person who required assistance at my table was not offered help. The portions were ample and there was an offer of 2nd helpings'

'I did not see any unsafe equipment'

'There appeared to be sufficient staff in the areas I visited, I did not see any distressed residents or any one waiting for attention'

'Residents and visitors to whom I spoke were aware of the complaints procedure, a member of staff told me that they would not be afraid of 'whistle blowing' if the need arose'

Two people spoke with the expert and raised complaints in relation to access to the community and food. We made these known to the Manager during our visit.

Relatives of people living at Broadoak Manor told us they were informed when people living in the home were admitted to hospital. Some relatives told us that the service did not always take good care of peoples' personal clothing. They told us that on occasions people's clothing went missing or their relatives were found to be wearing other people's clothing. A few people living in the service told us that they had made complaints about this but were not sure if any action had been taken to improve the situation.

We watched care workers interact with people living in the home during the day. The majority of care workers took the time to explain what was happening to people that they support. Care workers were observed supporting and encouraging people with their daily routines. During the visit we saw care workers demonstrate good support given to people at meal times and in general activities.

We noticed that on the majority of the units people were told what the food was that they were eating and asked if they wanted it. This was often not a choice as an example care workers offered a single choice of soup as there was no alternative available. On other occasions during the day we saw care workers clearly ask people did they want a drink, or to watch the television. During or observations it was clear that care workers found it more difficult to offer and support making an informed choice for people unable to express themselves clearly.

People spoken with told us "The foods not very good, we don't get much variety' 'we do have good soup, but they spoil it by putting too much salt and pepper in. It should be left so we can put our own in' 'We get tea and toast at night, that's very good it sends us off to bed' 'They bring us to table for meals and then leave us waiting too long"

Relatives spoken with during our visit told us, 'Can't fault it at all here' 'mum is eating so much better since she came here, we didn't think she would survive when she first came in. They have been very good with her'. Another said, 'She is looked after very well, no problems. She eats very well'.

We received information from Social Services regarding a number of people living in the home. Social Services had concerns regarding "disagreements" between people living in the home and management of head injuries following people falling. The manager had been aware of these incidents as they had been reported to Social services by the manager. She described some of the actions that the service intended to take to deal with these concerns in the future. This including making sure that people who had an injury following a fall were seen as soon as possible by someone with a medical background. Social Services informed us that they are undertaking a number of reviews of people living in the service to determine their care needs.

We spoke with a visiting professional who deals exclusively with people at the end of their lives. They informed us that the service had made "significant" improvements' in this area. We were also told by them that they were confident that the vast majority of people at the end of their lives had their care needs and their personal wishes meet.

Two visiting professionals to the service told us that in their opinion the care within Broadoak Manor continued to improve.

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When we looked at care issues we noted that one person had run out of medication for four days this had not been recognised by the services own audits and checks. Two people had lost weight that had not been recognised and one person had a bruise that could not be accounted for. Following our visit the service contacted Social Services to refer the information for a safeguarding review. Social Services advised the service that these issues did not need to be managed by safeguarding and the service undertook to investigate the concerns in order to improve practice.

A relative informed the inspector that they were concerned about the attitude of one member of staff and a number of items of clothing that consistently went missing. We spoke to the unit manager who was aware of the relatives concerns and had taken action regarding this information. The relatives told us that the person's attitude had been reported by them to the previous unit manager on several occasions and on one occasion their relative had been upset. A number of people living in the service and relatives were concerned regarding missing items of clothing and incorrect clothing being given to people living in the service. None of these concerns had been passed to the manager for her to determine what actions needed to be taken.

We spoke to people living in the service and their relatives. They were confident that care workers maintained their confidentiality. At our visit we observed that care records confidential to the person living in Broadoak Manor were kept secure, with access by care workers as needed.

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Broadoak Manor Care Home

All Inspections

06 May 2015

During a routine inspection

14, 18 August 2014

During an inspection looking at part of the service

10 December 2014

During an inspection looking at part of the service

29, 30 April 2014

During a routine inspection

8 August 2013

During a routine inspection

30 November 2012

During a routine inspection

9 January 2012

During an inspection looking at part of the service

1 August 2011

During a routine inspection

Reports under our old system of regulation