This inspection took place on 3 April 2018; the inspection was unannounced.

Broadgate Care Home is a ‘care home with nursing’. People in care homes receive 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.

Broadgate Care Home accommodates up to 40 people in one adapted building. At the time of our inspection 32 people lived at Broadgate Care Home.

At our last comprehensive inspection in October 2015 we rated the service as 'Good.'

At this inspection we found a piece of equipment, which should have been decommissioned due to signs of damage, had been used to help people mobilise.

We have made a recommendation regarding the management of risk.

People did not always have use of their own continence products as staff believed they had none available; this meant there was a potential risk to their skin care.

Required pre-employments checks had not always been recorded as being completed. Checks that nurses’ registration with the Nursing and Midwifery Council had been renewed had not been undertaken at the time they were due for renewal.

Although activities were provided and people had been asked about how they enjoyed spending their time, we could not see this had led to satisfying and meaningful activities and interests for all people to partake in.

Systems to assess and monitor the quality and safety of services and reduce risks were not always effective.

The service is required to have 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 was a registered manager in post and they were present at the inspection.

People and relatives felt the registered manager was approachable. However some staff reported the registered manager did not listen to them and that he was difficult to talk with.

Surveys of people’s and their relatives' views had been completed, however it was not always clear what actions had been taken in response to this feedback.

Staff were supported with training to provide care in line with the service’s aims. However some people experienced poor outcomes as they were unsatisfied with the support provided to pursue activities of interest to them.

Most, but not all people, received care in a timely manner. The number of staff required to provide care for people had been calculated based on people’s needs. However, staff had not always been deployed in a way that meant people always received timely care.

People told us they felt safe and staff had been trained and showed an understanding about how people could be at risk from harm and abuse; staff were able to tell us how they would raise their concerns if this was the case.

People had care plans and risk assessments in place. Risks to people associated with their healthcare conditions were assessed and actions identified to reduce any identified risks. Other risks associated with medicines and infection prevention and control were also assessed. Medicines were managed, administered and stored safely. People could have their medicines when they needed them and records were kept of any medicines administration. Actions were taken to reduce risks from infection.

People’s care needs were assessed and were in line with current legislation, including the MCA. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s care involved other healthcare professionals when needed. Staff had been trained to meet people’

We carried out an unannounced inspection of the service on 11October 2015.

Broadgate Care Home provides accommodation and personal care and nursing care for up to 40 older people including people living with dementia and physical needs. Accommodation is provided over two floors. 30 people were living at the service at the time of the inspection.

Broadgate Care Home is required to have 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. At the time of the inspection a registered manager was in post.

At our last inspection on 5 and 6 November 2014 we found the provider was in breach of Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010. Assessing and monitoring the quality of service. The provider did not have an effective system in place to regularly assess and monitor the quality of the service provided. Following this inspection we received an action plan in which the provider told us about the actions they would take to meet the relevant legal requirement. During this inspection we found that the provider had met this breach in regulation.

The provider now had checks in place that monitored the quality and safety of the service. This included enabling people and their relatives and representatives and staff to give feedback about their experience of the service.

People received a safe service because risks were assessed and managed appropriately. Staff were aware of the safeguarding procedures in place to protect people and had received appropriate training. There were safe management and administration of medicine processes. Safe recruitment practices meant as far as possible only people suitable to work for the service were employed.

Accidents and incidents were recorded and appropriate action was taken to reduce further risks. Risks plans were in place for people’s needs that were regularly monitored and reviewed. Additionally, the environment and equipment had safety checks in place.

There were sufficient staff available to meet people’s needs. People’s dependency needs were reviewed on a regular basis and staffing levels amended to meet people’s changing needs.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. This is legislation that protects people who are unable to make specific decisions about their care and treatment. It ensures best interest decisions are made correctly and a person’s liberty and freedom is not unlawfully restricted. People’s rights were protected because staff were aware of their responsibilities and had adhered to this legislation.

People were supported to receive sufficient amounts to eat and drink. People received a choice of food and drink and menus provided people with a nutritional diet. People received appropriate support to eat and drink and independence was promoted.

Relatives and people that used the service said that staff were knowledgeable about their needs. People’s healthcare needs had been assessed and were regularly monitored. People were supported to access healthcare services to maintain their health.

Staff were appropriately supported. This consisted of formal and informal meetings to discuss and review their learning and development needs. Staff additionally received an induction and ongoing training.

People and relatives we spoke with were positive about the care and approach of staff. They were caring, compassionate and knowledgeable about people’s needs. People’s preferences, routines and what was important to them had been assessed and were known by staff.

The provider supported people and their relatives or representatives to be actively involved in the development and review of the care and support they received. This included regular discussions with people and formal meetings.

People told us they knew how to make a complaint and information was available for people with this information. Confidentiality was maintained and there were no restrictions on visitors.

When we visited the service on 28 and 29 May 2014 we had some concerns about cleanliness and infection control. We took enforcement action against Broadgate Care Home to protect the health, safety and welfare of people who used the service. We checked during this inspection to see whether the required improvements had been made.

During the inspection we spoke with four people who used the service. We also spoke with six staff, including the acting manager. We did a tour of most of the premises. We also looked at some of the records held in the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We spoke with four people who used the service. Three people told us they felt the care home was kept clean. The fourth person did not provide any feedback that related to this outcome.

Staff told us they felt the care home was kept clean. Several staff told us improvements had taken place since we inspected the care home in May 2014. One staff member told us it was not 100%, but said, “It’s getting better.”

We did a tour of most of the premises. We did not notice any unpleasant odours. We looked at 12 of the bedrooms. We saw bedrooms were clean.

We looked at communal lounges and saw these were clean. However, the provider may find it useful to note we saw a chair in the corner of one lounge that was marked with what looked like food stains. We found that the chair had not been moved from the room when the staining occurred the evening before. This meant there was a risk that people who used the service would use a chair that was not clean. We saw later during our visit that the chair had been taken away and cleaned.

We looked at bathrooms and toilets. We saw these were clean.

The acting manager told us most staff had received infection control training since our inspection in May 2014 and training for other staff was planned for October 2014.

People expressed their views and were involved in making decisions about their care and treatment. One relative told us, “I get a lot of information from the home about my family member and I am pleased with that.”

We found that improvements had been made in relation to people’s consent to their care and treatment since our previous inspection. However; the provider had not fully completed the improvements about which they had informed us and improvements had not been made in line with the provider’s own timescales.

We saw that people’s individual needs and risks had been assessed including their pressure care, nutrition and risk of falls care needs. We found that identified needs and risks had been reviewed regularly since our last inspection.

One person who used the service told us, “I’ve been in a few other care homes and the care I’ve received here has been the best.”

There were effective systems in place to reduce the risk and spread of infection.

During our inspection we toured the service and found that rooms were well maintained, including people’s bedrooms and communal areas.

Records were kept securely and could be located promptly when needed. We found that people’s care plans were stored and secured appropriately.

Residents and their relatives told us they had been provided with sufficient information about the service but they had not all been involved in making decisions about their care. Most people said their privacy was respected by staff. One relative told us “I’ve heard staff talking respectfully to other residents. They don’t know I’m [nearby].”

Most people felt all their needs were met by the service. One relative told us “Staff are sensitive to…[the resident’s] needs. Residents and relatives were positive about the quality of activities at the service. Residents said they felt safe living at the service and would know what to do if they were worried about anything. One person said “I’ve never had cause to complain.” Most people felt that staff showed them respect and ensured their dignity was maintained.

Most of the people we spoke with thought there were generally enough staff to meet their needs and were rarely kept waiting after calling for staff help. Most people also felt staff were well trained to meet their needs and were competent at their job.

Residents and relatives were mostly aware of how their views, on the quality of the service provided, were bring sought; and they made positive comments to us about the service. They spoke of meetings for residents and relatives and of quality satisfaction questionnaires they had completed. One relative told us, when it came to them needing a care home, “I’d come here.”

Residents and their relatives told us they had been provided with sufficient information about the service but they had not all been involved in making decisions about their care. Most people said their privacy was respected by staff. One relative told us “I’ve heard staff talking respectfully to other residents. They don’t know I’m [nearby].”

Most people felt all their needs were met by the service. One relative told us “Staff are sensitive to…[the resident’s] needs. Residents and relatives were positive about the quality of activities at the service. Residents said they felt safe living at the service and would know what to do if they were worried about anything. One person said “I’ve never had cause to complain.” Most people felt that staff showed them respect and ensured their dignity was maintained.

Most of the people we spoke with thought there were generally enough staff to meet their needs and were rarely kept waiting after calling for staff help. Most people also felt staff were well trained to meet their needs and were competent at their job.

Residents and relatives were mostly aware of how their views, on the quality of the service provided, were bring sought; and they made positive comments to us about the service. They spoke of meetings for residents and relatives and of quality satisfaction questionnaires they had completed. One relative told us, when it came to them needing a care home, “I’d come here.”

We spoke to two people, but they were not able to give any insight into their care, or how that care was delivered. However both people did say that they liked living at Broadgate Care Home, and they were very happy there.

The people who live at the care home, who we spoke to, were not able to give a view on how well or to what extent they were protected by the staff team’s knowledge or understanding of the safeguarding policies and procedures.

One member of staff said that the provider had visited a couple of times, but he made no attempt to speak to either staff or people who live at the care home, having come for a meeting, and he left straight afterwards.

Broadgate Care Home provides accommodation and personal and nursing care for up to 40 older people. Accommodation is provided over two floors. 27 people were living at the home at the time of the inspection.

This was an unannounced inspection, carried out over two days on 5 and 6 November 2014.

We last inspected Broadgate Care Home on 29 September 2014. At that inspection we checked to see whether the provider had taken action in response to enforcement action we had taken in relation to cleanliness and infection control. We found that the provider was meeting this essential standard.

The home was also inspected on 25 and 26 May 2014. At that time it was not meeting five other essential standards. We asked the provider to take action to make improvements in the areas of respecting and involving people who use services, care and welfare of people who use services, staffing, assessing and monitoring the quality of service provision and records. We received an action plan dated 30 July 2014 in which the provider told us about the actions they would take to meet the relevant legal requirements. During this inspection we found that the provider was meeting most of these. However, we found that the provider was not meeting the essential standard in relation to assessing and monitoring the quality of the service provided. We found that some improvements were still required.

There was 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 2008 and associated Regulations about how the service is run. However, the registered manager was not in post and not managing the regulated activities at this location when we visited. An acting manager was in post and was present during the inspection.

People living in the home told us they felt safe. Systems were in place for the provider to make safeguarding referrals when needed so that they could be investigated. Risk assessments were completed regarding people’s care.

A person told us they received their medicines on time and we observed a staff member administering medicines in a safe way. However, we found some gaps on the medication administration record charts that were used to record whether people had taken or not taken their medicines.

We found there were enough staff present during the inspection to meet people’s needs. Robust staff recruitment processes were in place. Staff had the knowledge and skills to care for people safely. We saw that the premises and equipment were safe.

Staff received induction, supervision and training and knew about people’s needs. People were happy with the food provided at the home. Referrals were made to health care professionals for additional support when needed.

People were asked for their consent. Staff told us they had received training on the Mental Capacity Act 2005 (MCA). However, we saw that a small number of MCA assessment forms had not been completed correctly.

We observed that staff were caring and kind and treated people with dignity and respect.

We observed staff asking people for their views and providing care in a person-centred way. However, we did not always see evidence in people’s care records about how they had been involved in decisions about their care. We found that some care records required additional information about people. We received some feedback that more activities were needed.

There were systems in place to monitor the safety and quality of the service provided and to address risks. However, we found some improvements were required to improve the effectiveness of these. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.