About the service:

Broadoak Lodge is registered to provide accommodation and personal care for up to 27 adults. At the time of our inspection there were 24 people using the service.

People’s experience of using this service:

Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report these types of concerns. People had risk assessments in place to enable them to be as independent as they could be in a safe manner.

Staff knew how to manage risks to promote people’s safety, and balanced these against people’s right to take risks and become more independent. There were sufficient staff with time to support people with their required needs and take part in activities of their choice.

Effective recruitment processes were in place and followed by the management team and provider. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people from cross infection.

People were supported to make decisions about all aspects of their life; the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards underpinned this. Correct processes were in place to protect people. Staff gained consent before supporting people and respected their decisions.

People were encouraged to have choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice.

Staff received an induction process and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. Staff were also supported by managers through supervisions.

People could make choices about the food and drink they had, and staff gave support when required to enable people to have a balanced diet. People were supported to access a variety of health professionals when required, including opticians and doctors to make sure people received healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained. Care plans were written in a person-centred way and were responsive to people’s needs. People were supported to follow their interests.

There was a complaints procedure which was accessible to all. Complaints had been responded to appropriately. Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

The registered manager managed the service. The assistant manager was in the process of applying to be a registered manager also.

Rating at last inspection:

At our last inspection we rated the service as requires improvement in the domains of Safe and Well-Led. This report was published on 02 February 2018. At this inspection we found evidence that these ratings were now good.

Why we inspected:

We carried out this inspection based on the service's previous rating. At the last inspection we found three breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The service was rated Requires Improvement in Safe and Well-led. We required the service to make improvements and the provider informed us what they would do to meet the regulations.

More information is in the full report.

Follow up: We will continue to monitor the home in line with our regulatory powers.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We undertook this focused inspection on 16 November 2017. This inspection was partly prompted by an incident which had a serious impact on a person that indicated potential concerns about the management of risk in the service. Shortly after our inspection visit we were made aware of another serious incident. The investigation into this is on-going.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Broadoak Lodge on our website at www.cqc.org.uk.

We carried out this focused inspection on 16 November 2017 and the inspection was unannounced. Broadoak Lodge is a care home without nursing and provides care and support for up to 27 older people including people living with dementia. At the time of the inspection there were 25 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.

There were not always sufficient numbers of staff to meet people’s needs or to keep them safe.

Staff knew how to recognise the signs of abuse and what action to take should they suspect it. However, the registered manager failed to report a serious allegation to the local authority safeguarding team or to the CQC. This meant that people may not always be protected from abuse.

People told us they received their medicines in the right way and at the right time. We saw that staff followed correct procedures for the safe administration of medicines. However, where medicines were prescribed on an as required basis, there was insufficient instruction to staff about when this medicine should be given. This meant there was a risk of inconsistency as to the amounts of medicines given.

Risks were assessed and management plans were in place to reduce the risk. For example, some people had a pressure mat that alerted staff when they stood up if there was a risk they would fall. However, because staffing levels were not always sufficient to meet people’s needs there was a risk there may not be enough staff to respond to the pressure mat alarm. In particular there were instances of only two staff members being on duty at night. If both of these staff members were attended to a person that required two staff to help them mobilise then there were no staff available to respond to or monitor other people’s needs.

Daily health and safety checks were carried out on the premises and environment. Routine maintenance and safety checks were also carried out such as checking hoists and electrical and gas appliances were safe to use. However, routine maintenance work on the hot and cold water systems had not been carried out since January 2017 despite the providers own policy stating this should be done every two weeks. Staff had not had a fire drill since our last inspection.

Quality monitoring did not effectively identify issues or lead to improvements. People and staff felt supported by the registered manager and felt they were approachable and accessible. We identified that improvements were required at our comprehensive inspection in April 2017 but action had not been taken to improve.

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

We inspected the service on 13 April 2017 and the inspection was unannounced. Broadoak Lodge is a care home without nursing and provides care and support for up to 27 older people including people living with dementia. At the time of the inspection there were 20 people using the

service.

There was a registered manager in post. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff understood their responsibilities about protecting people from abuse and avoidable harm. Risk was assessed and management plans were put in place.

Some people said they had to wait a long time for staff to attend to them. Other people said that staff responded promptly when they called for assistance. We have made a recommendation about the deployment of staff.

Pre employment checks were carried out so that so far as possible only staff with suitable character and skills were employed.

People's medicines were managed, stored and administered in line with current professional guidance. Staff were not following the protocol for an 'as required' medicine for one person. Action was taken to address this during our visit.

Staff had received training and support to carry out their roles, and knew how to meet people's individual needs. Consent was sought in line with legislation and guidance.

People were supported to eat and drink a varied and nutritious diet. They had access to the healthcare services they required.

Staff were caring and had developed positive relationships with people. People had their privacy and dignity respected.

Care and support was delivered in the ways that people preferred. People felt comfortable making a complaint and confident they would be listened to.

The culture of the service was open and inclusive. There was a clear organisational structure and staff understood their responsibilities. The quality of the service was monitored and changes were made to continually improve.

We inspected Broadoak Lodge on 9 August 2016. This was an unannounced inspection. This meant that the staff and provider did not know that we would be visiting.

At the last inspection on 3 and 4 December 2015, we asked the provider to take action to make improvements to the safe care and treatment for people who used the service, safeguarding people from abuse and improper treatment, staffing, good governance and notifying us of events that happened at the service. We found that most of these actions had been completed. We received information from the provider about how they would address these concerns on 10 February 2016. This identified work that had been undertaken and the planned works to improve the service.

Broadoak Lodge is a care home registered to provide accommodation for up to 27 older people who are living with dementia, or who have a learning disability or autism spectrum disorder. On the day of our inspection 23 people were using the service.

The service does not have 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’ A registered manager from another service had been covering the post full time and had been since March 2015. The manager told us that they were in the process of applying to become the registered manager for Broadoak Lodge.

People were now protected from the potential for harm from the actions of other people living in the service. Most risks had been assessed. Guidance had been provided for staff on how to manage risks that people may display. Staff were following this guidance. However people were not consistently protected from risks relating to their health and safety. Staff were not always following risk management plans that were in place.

People were protected from abuse. Where incidents had occurred they were recorded on 'incident report' forms. However details of the investigation had not been recorded on these forms. Policies had been updated and staff were aware that they could raise any concerns with outside agencies.

Staffing levels had been increased since our last visit, though people sometimes had to wait for their needs to be met. Staff had been recruited using recruitment processes to make sure that staff were suitable to work with people who used the service.

People’s tablets and liquid medicines were handled safely and were given to them in accordance with their prescriptions. Where some people had cream prescribed for them we found that staff were using creams that had been prescribed for other people. We found that where this was happening the creams being used were not always the prescribed cream.

Checks and risk assessments to make sure the building was safe had been completed. Evacuation plans had been written for people to help support them safely in the event of an emergency.

Staff received support through an induction to the service and supervision. There was an on-going training programme to update staff on safe ways of working. However, we found that staff had not been trained fully to meet the needs of people who used the service. Training records showed that night time staff had not been trained to administer medicine.

People were supported to access healthcare services when they needed them. However, the provider did not always ensure that advice given by health professionals was followed.

Where people’s food intake needed to be monitored to reduce the risk of malnutrition the amount of food people had been given was not recorded.

Staff told us that they sought people's consent before the provided care and support. Some people were subject to restrictions in order to keep them safe and meet their care needs. The manager had

This inspection took place on 3 and 4 December 2015. The first day of the inspection was unannounced. We told the provider that we would be returning for a second day. We started the second day of the inspection at 5.30am as we had identified some concerns about people being woken up early.

At our last inspection of the service, 27 and 28 August 2015 the provider was failing to meet two regulations. These related to governance and safe care and treatment. We issued the provider with a warning notice in relation to governance at the service and told them that they needed to improve. We also issued them with a requirement notice relating to providing safe care and treatment at the service. At this inspection we found that the provider had failed to address all of the concerns and we identified further concerns about the health, safety and wellbeing of people at the service.

Broadoak Lodge provides accommodation, care and support for up to 27 people who require personal care. On the day of our inspection 25 people were using the service. There should be a registered manager at the service. 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. The service did not have registered manager in post although a registered manager from another of the provider’s services was working at the service.

People were not consistently protected from risks relating to their health and safety. Risks had not always been assessed. Where there was guidance in place for staff to follow to reduce risks associated with people's care this was not consistently followed.

People were not protected from abuse. People were made to get up early, sometimes up to four hours before their preferred time to rise, without any choice and this was abusive. Allegations of abuse and safeguarding incidents had not been reported or investigated appropriately and so people had been denied the oversight and protection of the council and the Care Quality Commission.

People told us that the staff were kind and caring. However, we found that people had to wait for their needs to be met as there were not sufficient staff at the service. Staff did not have the time to get to know people and respond appropriately to meet their needs. People did not always receive choices or communication from staff about how and where they spent their time.

People were at risk of not receiving their medicines as prescribed. This included medicines prescribed for severe heart, eye and metal health conditions. There was not always clear guidance for staff to follow to ensure that people received their medicines when and how they needed them. Some staff who were expected to administer important medicines had not received training on how to do so and did not have ready access to them. Recordings of the administration of medicines were inconsistent.

People received care from staff that had undergone the appropriate pre-employment checks. Staff had not all received appropriate training and support to enable them to fulfil their roles. Night staff on duty for example had not received any training from the provider in relation to their roles, including their responsibilities to administer important medicines and to use necessary moving and handling equipment.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). Where there was a reasonable doubt that a person lacked capacity to make decisions the service had a mental capacity care plan in place. However, the information relating to the people’s mental capacity was not decision specific and therefore did not fully meet the requirements of the MCA legislation. The service had taken appropriate steps where they had identified that peo

We carried out an unannounced inspection of the service 18 March 2015.

Broadoak Lodge provides accommodation for up to 27 people who require personal care. On the day of our inspection 26 people were using the service.

There was a registered manager employed at the service but at the time of our visit they had relinquished their management responsibilities and were working as a member of the care team. 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 our last inspection 25 September 2014 we asked the provider to take action to make improvements to protect people living at the service. The provider was not meeting three Regulations of the Health and Social Care Act 2008. These were in relation to people’s care and welfare, staffing and assessing and monitoring the quality of care provision. The provider sent us an action plan to tell us the improvements they were going to make. During this inspection we found there were continuing breaches to these regulations.

People told us that they felt safe living at Broadoak Lodge. At the time of our inspection there was an active safeguarding investigation into a high number of pressure sores. Six people had developed pressure sores in the last six months. We found there were gaps in recording about when people had their position changed to reduce risk. Risk management plans were not always effective and some people were not properly protected.

People and their relatives told us that staff were very busy. Low staffing levels had resulted in one person falling at night because the two staff on duty were busy attending to another person. Staffing levels were decided by the provider but they were not based on the needs of people who used the service.

People told us they received their medicines at the right time and as prescribed by the doctor. There were some recording inaccuracies and insufficient guidance for staff about ‘as required’ medicines and when these should be given.

People mostly said that staff were trained and knew how to meet people’s needs. Not all staff had received the training they required and we were given examples of how people with dementia did not always have their needs met.

Verbal consent was gained before staff carried out any care and support and staff were clear about promoting people’s choice and autonomy. We saw mental capacity assessments had been completed for some people who lacked mental capacity to make decisions about their care and treatment. However these were not decision specific and therefore did not fully meet the requirements of the MCA legislation.

People told us they liked the meals provided. Risk of malnutrition was assessed and action was taken to reduce the risk. Records for fluid intake were maintained but sufficient action was not taken when daily fluid intakes were low. People had access to healthcare professionals when this was required. For example people were referred to dieticians, community nurses and mental health teams.

Interactions between staff and people who used the service were positive and respectful. However, some of the language staff had used in daily records was not respectful and showed that some staff did not fully understand people’s need. Five people had dirty fingernails and relatives told us that at times they found their relatives clothes were food stained. Two people told us they did not have as many baths or showers as they would like. Records showed that some people had very few baths or showers in the previous three months.

Care plans were not personalised and did not include people’s preferred way of receiving care. People were not involved in the care planning and review process. There were very limited opportunities for people to pursue their hobbies and interests or engage in any activity.

People told us they could make a complaint and would feel comfortable doing so. Two relatives were unsure about who was managing the service. Not all complaints were recorded and complaints were not used as an opportunity for learning and improvement.

The provider’s action plan to address the breaches to regulation found at our inspection in September 2014 stated that actions would be completed by January 2015. During this inspection we found that this action had not been taken. There was not an effective system in place to measure and review the quality of care. Satisfaction questionnaires were given to people who used the service and their relatives. This was last done in December 2014. There were 11 questionnaires returned. The majority of comments were positive but a lack of activities and not enough staff had been identified by one person’s relative. During our inspection we found that some radiators were very hot to touch. There was no risk assessment in place or action taken to reduce the risk.

Staff told us that their manager was approachable and would listen to them. However there had been a lack of consistency caused by frequent changes in the management arrangements at the service in the previous 12 months.

We found two breaches of the Health and Social Care Act 2008 Regulations during this inspection. You can see the action we have told the provider to take at the end of this report.

We spoke with four people who used the service and two visitors. People told us they liked the staff and were satisfied with the care and support they received. We found that people had their needs assessed and a plan of care was in place. Care plans did not properly set out the action staff should to take to meet people’s needs. Care plans did not record people’s preferences about the way they preferred to receive care and support. People were not always given the opportunity to be involved in the care planning process.

We found that there may not always be enough staff on duty with the required skills and experience. There were a high number of un-witnessed falls recorded. Some staff had not received all the training they required to do their jobs nor had not had their training updated.

People who used the service, their relatives and staff were not asked for feedback or for their views about the care and support provided. The acting manager could not find any record of quality monitoring carried out at the service in the last six months. We saw that accidents and incident were recorded but we could not see any evidence of action taken to reduce risk.

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 and to two relatives. They told us they were satisfied with the care and support provided. One relative told us " I spent christmas day here, they made me very welcome"

People were given choice and autonomy over their lives. There was a varied range of recreational and social activities. Staff interacted with people who used the service in a kind and respectful manner. We observed staff and explaining what they were doing and working in an unhurried way in order to reassure and meet individual need.

Staff were knowledgable about people's individual needs and about the providers policies and procedures. The manager sought advice and guidance from appropriate professionals when this was required.

We carried out this inspection to follow up non compliance we found at our inspection on 17 and 20 August 2012. We spoke with two people who used the service. People told us they received the care and support they required and that they liked the staff. One person told us 'I get on well with the staff'. We found that the provider had made improvements and achieved compliance in all the outcomes we reviewed.

We spoke with five people who used the servcie. People told us they liked the staff. Two people felt there not always enough staff on duty. Some people did not always feel safe living at Broadoak Lodge.

We carried out an unannounced comprehensive inspection of this service on 18 March 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Broadoak Lodge on our website at www.cqc.org.uk

We found that there were sufficient staff on duty to meet people’s needs. People told us that there were times when they had to wait for staff to assist them but that there needs were attended to within a reasonable time.

People’s care plans contained information about their life history and preferences. Relatives told us that people’s preferences were respected and that their needs were being met.

People’s care needs were assessed but they had not always been updated following any changes to people’s needs.

We found that some people were having to use the shower facilities in other people’s rooms as there was no communal shower room and not all rooms had a shower in the en-suite.

We found that the provider had employed a quality group manager who had been in post for five weeks. We found that they had recently introduced a number of audits to assess and monitor the quality of care. We were concerned that audits had failed to identify the issues that we found.

We were concerned that records relating to people’s care were not always fully completed and were not maintained securely.

We found that although some improvements had been made to the way that the service provided pressure care there were still some concerns about how the service was ensuring that risks were appropriately assessed and managed.

We found two breaches of the Health and Social Care Act 2008 Regulations during this inspection. You can see the action we have told the provider to take at the back of the full version of this report.