This inspection took place on 18 October 2017 and was unannounced. At our last comprehensive inspection of the service in July 2016 we gave the service an overall rating of requires improvement. We found the provider in breach of the regulations. People were at risk of harm from sharp items and falling from height from a large window at the service. Medicines were stored in a hot room and at risk of being damaged. There was no system in place to monitor and analyse accidents and incidents. The provider did not always obtain evidence to reassure themselves of staff’s suitability and fitness to work. The provider could not always demonstrate that they had acted lawfully when depriving people of their liberty.

Although not a breach of the regulations we also found staff had not received all the necessary training and support required to help them carry out their work effectively. Audits and quality checks had not been effective in identifying and addressing shortfalls we found at the service. There was no registered manager in post. Policies and procedures to help staff deliver consistent care had not been updated since 2010.

We carried out a focused inspection in January 2017 to check the provider had taken the action they said they would to meet legal requirements in relation to the breaches of regulation. We found some improvements had been made. A cooling device was installed in the room where medicines were stored and sharps bins containing hazardous items were no longer kept in communal bathrooms and toilets. The provider had also introduced an accidents and incidents register to help identify underlying causes or trends which may have contributed to these. We also found the provider was meeting legal requirements where people had been deprived of their liberty as part of their care, to help ensure this was in their best interests and as least restrictive as possible. However we found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to the safe care and treatment of people. The restrictors on the window at the top of a communal staircase were still unsuitable which meant people were still at risk of falling from height. We served a warning notice on the provider and asked them to make the necessary improvements by 17 February 2017. We also found gaps again in recruitment records which meant the provider was still not assuring themselves of staff’s suitability and fitness to support people. You can read the reports from our previous inspections, by selecting the 'all reports' link for Broadlands Nursing Home on our website at www.cqc.org.uk

Broadlands Nursing Home provides personal and nursing care for up to 25 people. At the time of our inspection there were 18 people using the service some of whom were living with dementia.

At this inspection we found the provider had taken action to meet legal requirements and had made improvements. The window at the top of the communal staircase was now fitted with a robust restrictor which meant the risk of people falling from height from this window had been reduced. Recruitment records showed the provider was carrying out appropriate checks and obtained the necessary evidence to assure themselves of staff’s suitability and fitness to support people.

Since our last inspection the provider had made further improvements to other aspects of the service. Records maintained about accidents and incidents had been updated to provide better insight into people’s behaviours so that appropriate action could be taken to reduce risks to their, and others, health and safety. The provider had improved training and supervision (one to one meeting) arrangements so that staff were better supported to help them meet people's needs more effectively. The provider had also reviewed and updated the service’s policies and procedures to bring staff up to date with information and guidance they needed to help them deliver consistent working practices.

This inspection took place on 24 January 2017 and was unannounced. It was carried out by one inspector.

Broadlands Nursing Home provides residential and nursing care for up to 25 people. At the time of our visit there were 16 people using the service. 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.

At our last inspection on 14 July 2016 we found three breaches of legal requirements in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, and fit and proper persons employed. The provider wrote to us with their action plan on 25 August 2016 and told us they would resolve these issues by 17 October 2016.

The purpose of this inspection was to check the improvements the provider said they would make in meeting legal requirements. At this inspection, we found that although the provider had made some improvements to the safety and quality of the service, they were still in breach of the regulations in relation to safe care and treatment and fit and proper persons employed.

Upper floor windows at the top of a communal staircase were still not fitted with appropriate restrictors to protect people from risks associated with falling from height. The restrictors in place were not tamper-proof and could be easily removed.

The provider was still not obtaining all of the information about staff that is required by law as part of recruitment procedures. They did not have appropriate systems in place to ensure a full work history was obtained for each member of staff.

We are taking further action against the provider for a repeated failure to meet the regulation in relation to safe care and treatment. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The provider had made some of the improvements that were necessary since their last inspection. They installed a cooling device to help ensure the room where medicines were kept was cool enough to store medicines safely. They also moved bins containing used razors from bathrooms into a secure room where people could not access them. They had put in place an accident and incident register that helped the registered manager identify any trends in accidents and incidents to help prevent reoccurrence.

The provider had taken action to ensure they were meeting legal requirements when people were deprived of their liberty as part of their care. They applied in a timely manner to the relevant bodies when they required authorisation to deprive people of their liberty and where these were granted, staff made sure they met any conditions attached to the authorisations. This helped to ensure restriction or deprivation of people’s liberty was in their best interests and as least restrictive as possible.

This inspection took place on 14 July 2016 and was unannounced. It was carried out by two inspectors. Broadlands Nursing Home has been previously inspected, but under a different registered provider. The provider deregistered and this service was registered under a new provider. This was the service’s first inspection since registration under the new provider.

Broadlands Nursing Home provides personal and nursing care for up to 25 people. At the time of our visit there were 19 people using the service. The service did not have a registered manager in post although a manager had been recruited and was due to commence work shortly. 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.

Although people and their relatives felt that the service was safe, the provider did not always identify and manage risks to people’s safety. For example, there were not sufficient measures in place to prevent people falling from upper floor windows or coming into contact with used razor blades. Medicines were not always stored safely because the temperature in the clinical room was too high. There was not an effective system to monitor accidents and incidents, identify themes and ensure appropriate action was taken. The provider was aware of this shortfall and was working towards putting such a system in place.

We also found that the provider did not always carry out the necessary checks on staff to ensure they were thoroughly vetted and of good character before their employment started.

When people were deprived of their liberty as part of their care and treatment, the provider had not ensured they were adhering to the requirements of the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

We found three breaches of regulations during the inspection. These were in regards to providing safe care and treatment, fit and proper persons employed and safeguarding people from abuse and improper treatment. You can see the action we have told the provider to take with regard to these breaches at the back of the full version of this report.

Equipment such as hoists and fire safety equipment were regularly checked and serviced to ensure they were safe to use. People had individual risk assessments and management plans to keep them safe from risks specific to them. There were enough staff to meet people’s needs and keep them safe. Apart from the high storage temperature, the provider managed medicines in a safe way.

Staff obtained people’s consent before delivering care and when people did not have the capacity to consent to their care, the provider acted within legal requirements.

Staff received a variety of training and support to carry out their roles effectively. However, there was insufficient evidence that new staff and night workers received enough training and formal support for this.

People received a choice of nutritious food and drinks and their nutritional health was monitored appropriately. However, action taken by staff to ensure people ate healthily was not always recorded in care plans to ensure consistency in the delivery of care.

Staff were caring and respectful. People and their relatives told us the service was caring and they got on well with staff. Staff took time to get to know people and their communication styles and gave them appropriate support to make decisions about how their care was provided. Staff kept people informed about what was happening in the home. People told us staff respected their privacy and dignity.

People received personalised care that was r