The inspection was unannounced and took place on the 20 July 2017. In January 2017 the service re-registered with the CQC and therefore the service had not been inspection under this registration.Broadoak Manor is registered to provide accommodation and personal care for up to 120 people. The service specialises in providing nursing care to older people living with dementia and physical health needs. The service consists of four houses, three of which provide nursing care, whilst another provides residential care for people living with dementia. At the time of the inspection there were 116 people using the service.
There was a registered manager in post within the service who had been registered since February 2017. 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.
During the inspection we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because audit systems were not always effective at identifying issues within the service. Equipment in two of the units had not been cleaned which placed people at risk of infection. We also identified two staff bathrooms that had been left unlocked and accessible to people, within which water exceeded safe temperatures. This placed people at risk of scalding themselves.
People’s care records contained details regarding their sensory needs and in some examples we observed people wearing their glasses and hearing aids as required. However, in one unit one person was unable to locate their glasses. In the same unit there were eight pairs of glasses being stored in the lounge, however staff did not know who these belonged to, and the lenses were scratched and dirty. We have made a recommendation to the registered manager around ensuring people’s sensory needs are met consistently.
Activities were available to people. However some people commented that they sometimes felt bored, whilst other people told us there was plenty to keep them occupied. This pointed at a disparity between the provision of activities in the different units. During the inspection we saw examples of activities taking place, and positive social interactions between staff and people. We raised people’s comments with the registered manager so that she could look into this.
People received their medication as prescribed. We looked at a sample of medication in two units and found that the quantities being held were correct. Staff signed medication administration records (MARs) as required to show that medication had been administered. Medication was being given in a timely manner, and clear instructions were available for staff on when to administer this.
There were sufficient numbers of staff in place to meet people’s needs. We checked staffing rotas and identified that there were consistent numbers of staff in post for each shift. Some people commented that they sometimes had to wait if they pressed their call bell, however they told us they did not have to wait too long and they received the support they needed.
Recruitment processes were robust and helped ensure staff were of suitable character to work with vulnerable people. Checks were completed prior to new staff being employed to make sure they did not have a criminal history, or were not barred from working with vulnerable people.
Staff had received the appropriate training required for them to carry out their role effectively. For example they had completed training in areas such as moving and handling, dementia and safeguarding. People also commented positively on the support they received from staff, and we observed examples of good practice in their interactions.
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. We observed examples of good practice where staff offered people choice, and people told us they did not feel restricted.
People were supported to have an appropriate diet that met their needs. Staff gave people the support they needed during meal times, for example by cutting food up or helping them to eat. The kitchen was well stocked with a variety of produce needed to meet people’s nutritional needs.
Staff were kind and caring in their approach towards people. People presented as relaxed in the presence of staff and there was a lot of laughter and discussion. Staff offered reassurance to people where they were at risk of becoming distressed, and acted promptly to relieve any discomfort.
People’s privacy and confidentiality was protected. Staff knocked prior to entering people’s bedrooms, and ensured that doors were closed whilst helping people attend to their personal care needs. Records containing personal information about people were stored securely, and staff ensured that offices and cabinets containing this information were made secure when not in use.
People each had a personalised care record in place which outlined their needs and how staff should act to support them. These also included details of any risks associated with their needs, and the action that should be taken by staff to mitigate these risks. Personal information relating to people’s likes and dislikes was also included, which helped staff to get to know the people they were supporting.