This inspection took place on 24 October 2017 and was unannounced. We returned on the 25 October 2017 to complete the inspection. The registered manager was given notice of the second date, as we needed to spend specific time with her and the provider to discuss aspects of the inspection and to gather further information.

We undertook an unannounced comprehensive inspection of Broadland View on 08 November 2016. We found continued breaches in Regulations 9, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was from a previous visit in September 2015. The service had failed to ensure that people's emotional and social needs were assessed and met. The management of the service had failed to have effective systems and processes in place to monitor and improve the safety of the service provided. For the Regulation 17 breach of Good Governance, we served a warning notice informing the provider that they had to comply with this regulation by 3 March 2017.

At that inspection, we also identified additional breaches of Regulation 11 and 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the service had failed to ensure people consented to the restrictions put in place surrounding people’s freedom of movement. The service had also failed to ensure that all peoples nutritional and hydration needs were met.

We undertook a focused inspection on 19 April 2017. This was to check the service had met the conditions in the warning notice and whether they now met the legal requirements for Good Governance. We found the service had made improvements and were no longer in breach of this regulation. We found that action had been taken to improve how the service assessed, monitored and improved the quality of the service provided. We did not improve the rating for well-led from requires improvement because to do so requires consistent good practice over time.

This inspection was completed to check that improvements to meet legal requirements planned by the provider after our 8 November and 19 April inspections had been made and sustained. The team inspected the service against the five questions we ask about services: is the service safe, effective, caring, responsive and well led. This is because previously, the service was not meeting some legal requirements.

Broadland View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Broadland View accommodates 25 people in one adapted building. There were 25 people living in the home on the day of our inspection. The home supported people who were over 65 years of age, some of whom were living with dementia.

There was 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 of the Health and Social Care Act 2008 and associated regulations.

At the inspection on 8 November 2016 we found there was a lack of knowledge and understanding in regards to when a Deprivation of Liberty Safeguards (DoLS) application was required. The service was therefore not acting in accordance with the Mental Capacity Act 2005/DoLS and seeking to reduce the restrictions as far as possible. These concerns constituted a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always involved in decisions about what they wanted to eat. We found food looked unappetising. For people who could not have a conversation with staff about what they wanted to eat and drink, the management team had not considered other ways of gaining this information. These concerns constituted a breach of

We carried out an unannounced comprehensive inspection of Broadland View Residential Home on 8 November 2016. Breaches of legal requirements were found. After the comprehensive inspection, a warning notice was served relating to the governance of the home.

We undertook this focused inspection on 19 April 2017, to check that the service had met the warning notice and whether they now met the legal requirements. This report only covers our findings in relation to the warning notice. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Broadland View Residential Home on our website at www.cqc.org.uk.

Broadland View Residential Home provides care for up to 25 older people, some of whom were living with different forms of dementia. The home is over two floors and was a former private dwelling. At the time of this inspection, there were 24 people living in the home.

There was 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. For the purposes of this report the registered manager will be referred to as the manager. There was also a ‘head of care’ and a private consultant. The private consultant was supporting the manager and the provider of the home.

At the last inspection carried out in November 2016, we asked the provider to take action to make improvements in the management and governance of the home. These actions had been completed. However, the rating remains the same as a period of sustained improvement is required in order for us to have confidence that these changes have been imbedded into everyday practice.

The service had effective systems in place to assess and monitor the quality of care people received. These systems helped to drive improvements in the service, which was noted at this inspection.

Audits had been introduced since our last inspection and these helped to monitor the standard of care delivered. These included audits around people’s dining and meal experiences, how staff interacted with people, the quality of care plans, and the competency of staff to perform their roles effectively.

At this inspection, sufficient improvements had been made by the service and they were no longer in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We concluded that the conditions of the warning notice had been met by the manager and the provider.

This inspection took place on 8 November 2016 and was unannounced.

Broadland View which was formally known as Shalom provides accommodation and support to a maximum of 25 older people, some of whom may be living with a form of dementia. At the time of our inspection there were 23 people living in the home. Broadland View comprises of accommodation over two floors. There are two bedrooms which are shared.

At our last inspection in September 2015, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person centred care, staffing, the safety of the premises and governance of the home.

At this inspection carried out in November 2016, we found continued breaches in Regulations 9, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found additional breaches of Regulation 11and 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

There was a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. During this report the registered manager will be referred to as the manager. There was also a deputy manager in place. At some points of the report we make reference to the management team, this relates to the registered and the deputy manager.

People did not always have thorough risk assessments with guidance for staff on how to manage particular risks to people’s health needs. Some cleaning products were not stored in a secure place. We found some unsafe practice with supporting people to mobilise.

People’s hydration and nutritional needs were not always being met by staff. People did not always receive the support they needed when they were eating and drinking. We found issues with the timings of meals, there were limited choices of what people had to eat and drink.

Staff did not always respond to people’s request for assistance. People’s dignity was not always protected. Staff were not fully responding to people’s social needs who lived in the home. There was a lack of social stimulation for many people in the home. Staff did not have the time to spend talking with people.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was depriving some people of their liberty in order to keep them safe. However, the service was not following the recommendations of one person’s DoLS. The service was not always complaint with the MCA.

There were organisation and planning issues with how staff were deployed around the home. There was also a lack of monitoring and testing that staff had the knowledge and skills to meet people’s needs. There was a lack of effective monitoring of the quality of the service. The audits which were completed were not robust.

People benefited from being supported by staff who were safely recruited, trained and who felt supported by the manager. There were enough staff to meet people’s physical care needs.

Staff understood how to protect people from the risk of abuse and knew the procedure for reporting any concerns. The service responded positively to a change in people’s health needs.

The service encouraged people to maintain relationships with people who were important to them. People’s relatives and friends were welcomed to the service and encouraged to visit.

Prior to this inspection, we had received information of concern from members of the public. This inspection was therefore carried out responsively. However, from the information gathered during this inspection, we were unable to substantiate the concerns raised with us.

We found that people were cared for appropriately and the home and its staff acted to ensure that people's care and welfare was maintained. Care planning was accurate and responsive and staff interacted positively with the people they were caring for.

We spoke with the relatives of four people using this service and each person expressed satisfaction with the service their loved one received. One relative told us, “Everything is fantastic; I can’t praise the home enough. It’s like one big family”. They further commented, “I could not fault the care, they turn (for pressure area care) and change [my relative] without fail.” A second relative commented, “The staff are wonderful and always very quick to help – my [relative] is happy enough.” A third relative told us that they thought the home met their relative's needs and they had no complaints.

Concerns were raised about the cleanliness of people’s bed clothes. On the day of our inspection however, all bedding checked was clean and fresh.

There were effective medication systems in place at the home.

Staff were trained and supported to undertake their roles and care for the people living at Shalom.

This inspection took place on 01 and 03 September 2015 and was unannounced.

Shalom Care Home provides accommodation and support for up to 25 people, some of whom may be living with dementia.

A registered manager was 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.

This inspection identified four breaches of the Health and Social Care Act 2008 (Regulated Activities Regulations) 2014. These breaches related to staffing levels, the safety of the premises, infection control practices, care planning and delivery and the governance of the service.

Staffing levels were insufficient to ensure that people’s needs could be met. Staff were usually able to meet people’s physical needs in a timely way. However, many people living in the service were living with dementia and required emotional support throughout the day to enhance their wellbeing. This was not always being provided as often there were no staff in communal areas of the home. Given the already low staffing levels in the home current staff were unable to provide any social support to people. This may have been detrimental to people’s sense of worth and wellbeing.

The staffing issues and levels had a knock-on effect to the manager’s capacity to improve the quality of the service people received. Monitoring systems in the home were not robust and had not been regularly utilised.

The premises were in need of prompt remedial action to reduce risks to people’s welfare and safety. Whilst the provider, their consultant and the home’s management team had been involved in discussions about the improvements needed for several months, no substantive improvements had been implemented. Infection control practices needed improvement to ensure the environment was a pleasant and safe place for people. Some of the issues we identified were already known about, but again had not been actioned.

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

Staff recruitment, training and supervision processes were robust. Staff found the training effective and informative.

Whilst people and their relatives were very positive about the standard of care and support received from the staff they were aware of the staffing issues and wanted to be supportive of the staff team. They gave us examples of how they had been consulted in the planning their care. They had confidence in the staff team and the home’s manager to sort out any concerns or complaints. Visiting healthcare professionals were also positive about the standard of care staff provided and that staff were quick to identify when people’s health required investigation or their intervention.

We observed that staff were thoughtful and considerate and took time to ensure that people were not rushed.