About the service:

Broadoak Park can provide care and accommodation for up to 30 people with needs relating to learning disabilities. There are seven residential bungalows and two flats. Other facilities include a resource centre for daytime activities and a clubhouse for entertainment.

Our last inspection took place in March 2016 when the service was rated good, although the effective domain required improvement due to findings regarding staff training and induction. At this inspection we found that the effective domain had improved and the service met the characteristics of a good service in all the key questions.

People's experience of using this service:

The provider had systems in place to safeguard people from abuse. Staff knew what action to take if they suspected abuse. Relevant risk assessments had been completed. The environment was monitored and safe for people to live in. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends.

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. Relevant mental capacity assessments had been completed.

A variety of meals were provided to people and people told us they took part in meal preparation. Assessments were seen which demonstrated relevant health professionals were involved in the care provided to people.

Care provided to people respected their privacy, dignity and promoted their independence. Staff knew people's needs well. We observed staff interacting with people and found they were kind and caring. Staff knew people well and responded to their needs in an understanding way.

Care plans had been completed and were regularly reviewed. These contained relevant information about how to meet people's needs. Where appropriate, plans were in place to ensure people's end of life wishes were taken into account and respected. The activities coordinator was employed to ensure the activities provided by the service met people's individual needs.

Feedback about the service was consistently good. Systems were in place to monitor the service, which ensured that people's risks were mitigated and lessons were learnt when things went wrong. There was an open culture within the service, where people and staff could approach the registered manager, who acted on concerns to make improvements to people's care.

More information is in the full report.

Rating at last inspection:

Good (Report published 15 April 2016).

Why we inspected:

This was a scheduled inspection based on the previous ratings.

Follow up:

We will continue to monitor the service through the information we receive.

We carried out an unannounced inspection of the service on 10 March 2016.

Broadoak Park provides accommodation and personal care for up to 30 people living with a learning disability or autistic spectrum disorder in seven bungalows and two individual flats. At the time of our inspection there were 22 people living at the service.

At our last inspection on 2 September 2015 the provider was in breach of two Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People who used the service were not protected against the risks associated with the management of medicines. People were at risk of not having their needs met by sufficient numbers of staff available at all times.

After the inspection the provider sent us an action plan to tell us of the action they would take to make the required improvements. At this inspection we found the provider had made these improvements to protect people’s safety and wellbeing. The breaches in regulation had been met.

Broadoak Park 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.

Improvements had been made to staffing, an ongoing recruitment drive was having positive results and agency staff were used to cover any shortfalls and vacancies. Staff were deployed appropriately to meet people’s individual needs. Staff responded to people’s needs in a timely manner and spent quality time with people.

People received their prescribed medicines safely. Improved systems had been introduced to check medicines were managed appropriately. Staff responsible for the administration of medicines had received refresher training.

People told us that they felt staff provided a safe service and risks were managed appropriately. Staff were aware of the safeguarding procedures and had received appropriate training.

Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. Risks to people’s needs had been assessed and plans were in place to inform staff of the action required to reduce and manage known risks. These were reviewed on a regular basis. The internal and external environment was monitored and improvements had been identified and planned for.

Improvements were required to the staff induction process and monitoring of training needs, to ensure staff had the required knowledge and skills to effectively meet people’s needs.

The manager had processes in place to apply the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS). People’s rights were protected and understood by staff.

People said that they received sufficient to eat and drink. They were positive about the choice, quality and quantity of food and drinks available. People received appropriate support to eat and drink and independence was promoted.

Staff were knowledgeable about people’s individual needs. People’s healthcare needs had been assessed and were regularly monitored. People were supported to access healthcare services to maintain their health and well-being. External professionals were involved in people’s care as appropriate.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. People received support to pursue their interests and hobbies and to participate in community activities. People had appropriate information abou

This inspection took place on 2 September 2015 and was unannounced.

Broadoak Group of Care Home is registered to provide accommodation and care at Broadoak Park for to up to 30 adults with learning disabilities. Accommodation is arranged in seven bungalows and two flats. Access to bungalows is mostly level, but access to flats is by a staircase. There were 22 people living in the home when we visited and no vacancies, as some of the current people needed more space around them than others.

There was a registered manager in post at the time of our inspection, but he was not present at the time of the 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 and associated Regulations about how the service is run. In the absence of the registered manager, an assistant manager was available and helpful throughout our visit.

People were not always safe, as not all medicines were managed safely and there were not always enough staff in the places they were needed. The provider did, though, use safe systems when new staff were recruited and risks to personal safety were minimised.

There were not always sufficient staff where they were needed to meet people’s needs safely at all times. Some staff had not been trained in all areas and may not have known how to meet people’s needs fully. Important changes in people’s needs were, though, passed on to all staff when they started their shifts, so that they were all aware of the up to date information about any incidents that affected people’s needs.

Staff were kind to people and cared about them. Choices were given to people at all times. People had appropriate food and drink and staff supported them individually to attend any health appointments so that their health needs were met. We found people’s privacy and dignity were respected and all confidential information was respectfully held securely.

Staff assisted people to take part in appropriate daily individual activities at home and in the community.

Some audits and checks were made on the quality of the service, but the provider had not regularly monitored the service in all areas in order to ensure the quality at all times.

During this inspection we identified two breaches 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 the report.

The inspection team who carried out this inspection consisted of one inspector to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report. We held conversations with five people who used the service to determine their views on the quality of service provision. We spoke with three representatives from the management team and two support staff. We also looked at some of the records held at the service which included support plans and maintenance records. We observed the support people who used the service received from staff and carried out a tour of the buildings and the grounds.

Is the service safe?

People who used the service were protected from the risk of abuse because the provider had taken all reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff told us they had received training in safeguarding vulnerable adults and records we saw confirmed this. Members of staff were able to tell us how they would respond to allegations or incidents of abuse and they knew about the reporting procedures within the organisation.

The CQC monitors the operation of the deprivation of liberty safeguards (DoLS) are in place which applies to care homes. DoLS are part of the Mental Capacity Act 2005. Correctly applied DoLS make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that care homes only deprive someone of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them.

The assistant manager told us two people had DoLS in place but also told us they planned to review the current needs of all of the people who used the service to establish whether a DoLS was required for them and submit the relevant applications to the assessing authority where appropriate.

The areas of the home that we saw during the inspection were clean, well maintained and free of risks to people’s safety.

We saw that there were sufficient staff available to meet people’s individual needs and records we looked at showed that staff had received training pertinent to their roles and responsibilities in the home.

We found that an on call system was in operation to ensure a member of the management team would be available at all times should an emergency situation arise.

Is the service effective?

Systems were in place to ensure that people’s individual support needs could be identified and met. We saw people’s support packages were delivered in such a way as to meet their individual needs and aspirations. We also found that staff had a good understanding of people’s individual preferences and how they were to be met.

We looked at the support plans of three people. We found them to be well maintained, person centred and they described in detail the needs of people and how they were to be supported. They also contained a range of risk assessments and where a risk had been identified there was a care plan in place which identified how that risk could be reduced.

We found support staff were able to provide a thorough account of people's needs and knew about people's likes and dislikes and the type of support they required. Staff also told us that they valued people’s support plans and believed them to be effective as they provided them with the reference and guidance they required.

We saw evidence that the service requested specialist advice from health professionals when required to ensure the service was effective in meeting people’s individual needs.

Is the service caring?

We observed interaction between staff and people living in the home on the day of our inspection. We saw people were relaxed and comfortable with the staff and staff had a good knowledge of people’s likes and dislikes.

We saw that staff treated people with dignity and the interactions appeared to be relaxed and empowering. Staff were ensuring that people’s choices were respected and all observed interventions were considerate and attentive to people needs whilst empowering them to make independent decisions.

We found that staff had received training in the promotion of dignity and one nominated dignity champion was in employment in the home. This is a government initiative aimed to put dignity at the heart of care services. The role of dignity champions was to stand up and challenge disrespectful behaviour. They act as good role models for their colleagues by highlighting how staff could promote people’s respect and dignity within a care home setting.

During our inspection we observed people’s privacy being respected. For example, we observed staff knocking on the bedroom doors and waiting for the person to say they could enter. We also saw people moved freely around the home during our visit. This meant people were supported with their independence.

Is the service responsive?

We found that systems were in place to ensure that people had their care and support needs assessed and kept under review and staff responded quickly when people’s needs changed. Whilst only one complaint had been received since our previous inspection we found the management team had responded to the complaint effectively.

Is the service well-led?

Members of staff told us they felt the management team supported them and respected their opinions. They told us they felt confident challenging and reporting poor practice and felt confident in using the organisation’s whistleblowing policy without fear of recrimination.

People who used the service, and their relatives, were provided with the opportunity to express their views within annual satisfaction surveys and residents meetings.

A member of the management team told us and records showed, that an analysis of the consultation process had been undertaken to develop the quality of the service whilst recognising where improvement could be made. This showed that people’s views were taken into consideration in developing the service.

Staff told us they received appropriate support and direction from the management team as they had received formal staff supervision and annual appraisals. These were in place to ensure staff could express their views and discuss any developments within the home.

We had received information suggesting that maintenance and repairs had not been carried out. We found evidence that this was true and people were not protected against the risks of unsafe premises that were not regularly maintained. The heating and hot water were difficult for staff to control and repairs had not been carried out in shower rooms. We also found some furniture needed attention, the garden areas were neglected and there was no internet connection for people to use the computers.

We received information of concern about there not being sufficient staff employed at Broadoak Park to meet the needs of the people living there. We found there had been sufficient care and support staff provided to ensure people engaged in some activities. However, we have informed the local authority social workers who may need to reassess the amount of individual one to one staff hours that are needed to provide further activities for the three people we observed.

We spoke with five people that used the service and we looked at the care files of three people. People who used the service told us they could choose what they did each day. We saw support staff working individually with people in their bungalows and in the resource centre.

Pictures and Widgit Rebus Symbols were used to help people understand their own plans and they were written in the first person to reinforce ownership and make them personal. There were clear assessments of foreseeable risks relating to all areas of care and support

People we saw told us they liked their own bedrooms. They had each made their rooms personal to reflect their individual interests and we saw that the premises were mainly well maintained.

People we spoke with smiled when we asked them about the staff. One person said, "(name of staff) knows how to help me" and another said, "There's always someone here, they help me."

We found that records of people's care were well maintained and held securely.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences. We observed staff interacting with people and using the training they had received in the way they communicated.

We could see from records within bungalows that staff were monitoring people's mood and general wellbeing. Staff told us that two of the people living there take part in quality circle meetings to discuss the service with the manager and staff. These meetings were held about every six weeks.

We spoke with six people altogether. Some were in their living areas and some in the resource centre within the grounds. Some people were able to tell us that they were happy with the support from staff. We observed the care given to people and found staff were following people's preferences and agreed actions in the care plans.

One of the more independent people living there told us, "I like living here. Overall, the staff do their best to help everyone in this situation."

We asked three people if they felt safe and they confirmed that they did. One said, "I feel safe and I know I can ask staff for help at any time."

There were staff supporting or supervising all the people we saw during our visit. Two people told us that staff were always with them. One person said " the staff always help me." Others were more independent and enjoyed their independence and responsibilities.

We could see that some staff had not been trained in signed communication, though they were working with a person whose care plan stated it was preferred in order to clarify communication. This person stated preference for another member of staff that was appropriately skilled, but was not currently on duty.

We did not speak to people who used services during this inspection. We have based our findings upon our inspection of documentation, a tour of the premises and discussions with staff.

We spoke with three people living at the service. Two people felt safe and knew who to talk to if they were unhappy. Another person told us that the staff were nice but also told us about an incident, which involved them and another service user. They gave us permission to discuss this with the registered manager. The manager told us that this incident had been the subject of a safeguarding referral and had been closed following an investigation.

People told us that they knew who to talk to if they were unhappy or wanted to make any comments about the service. They told us that they would speak with the manager directly if they had any concerns. People told us that they attended service user meetings, where they could discuss living at the home and two people told us that they had recently completed a survey.

We spoke with five people living at the service. Generally people were satisfied with the care in the home. One person told us that they liked living at the service and another person told us that they were happy with everything except the amount of activities that were available. A person told us that they felt safe however, another person, who was unable to speak to us but communicated using Makaton (a form of sign language), continually signed being hit and punched.