This inspection took place on 27 March 2018 and was unannounced. This meant no-one at the service knew we were planning to visit.

Broomcroft House 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. Broomcroft House is an 87 bed home providing personal and nursing care to older people with a range of support needs, including people living with dementia. There were 46 people living at Broomcroft House at the time of this inspection.

There was a registered manager employed 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 registered manager had a good oversight of the service and was experienced in their role. People, their relatives and staff told us the registered manager was supportive and approachable.

People were supported by staff who knew them well. Staff we spoke with were enthusiastic about their jobs, and showed care and understanding both for the people they supported and their colleagues.

Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the management team.

Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed.

There were enough staff to ensure people’s care and support needs were met. The service had robust recruitment procedures to make sure staff had the required skills and were of suitable character and background.

People and their relatives told us they enjoyed the food served at Broomcroft House, which we saw took into account their dietary needs and preferences.

We saw the signage and decoration of the premises were suitable to meet the needs of people living with dementia.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way, while promoting their independence. People told us they were treated with dignity and respect.

There was a range of activities and therapies available to people living at Broomcroft House. People were supported to engage in activities that were important to them.

People’s care records reflected the person’s current health and social care needs. Care records contained up to date risk assessments. There were systems in place for care records to be regularly reviewed.

There was a complaints policy and procedure in place. People’s comments and complaints were taken seriously, investigated, and responded to.

People, their relatives and staff were regularly asked for their views of the service. This promoted a culture of openness and empowerment with a focus on continuous improvement of the service.

There were effective systems in place to monitor and improve the quality of the service provided.

The service had up to date policies and procedures which reflected current legislation and good practice guidance.

Safety and maintenance checks for the premises and equipment were in place and up to date.

We carried out this inspection on 4 January 2017 and it was an unannounced inspection. This meant no-one at the home knew we were going to carry out the inspection.

Broomcroft House Care Home is situated in the Ecclesall area of Sheffield. The home is registered to provide of accommodation for up to 87 older people who require nursing and/or personal care. The first floor of the home meets the needs people who are living with dementia. On the day of our inspection there were 40 people living in the home.

Our last inspection of the home took place on 16 and 21 March 2016 and we found the home to be in breach of regulations for registration, person-centred care, dignity and respect, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, good governance and staffing. Requirement notices were given for these breaches in regulation and the registered provider was told to make improvements. On this inspection we checked improvements the registered provider had made. We found sufficient improvements had been made to meet regulations.

The manager had worked at the service June 2016 and was in the process of completing their registration with CQC. 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.

People who used the service told us they felt safe living in the home. Their relatives spoke positively about the improvements made at the home and were pleased with the standard of care and support their family member received.

Medicines were being safely stored and administered in line with prescribing instructions. We have recommended improvements are made to the medication administration records for Percutaneous Endoscopic Gastrostomy (PEG) feeding. PEG allows nutrition, fluids and medicines to be put in the stomach bypassing the mouth and oesophagus.

Reasonable and practicable steps to mitigate the risks posed to people who used the service had been taken and were kept under review.

Staffing numbers were sufficient to meet people’s needs and staff employed at the home had been recruited in a way that helped to keep people safe because thorough checks were completed prior to them being offered a post.

The nutritional and hydration needs of people were met. We have made recommendations that signpost the provider and the manager to guidance on management of nutrition and hydration.

People were encouraged to maintain a healthy lifestyle which included being provided with nutritious meals and being supported to attend healthcare appointments. People told us the food was “good” “nice” and “filling.”

Staff said the training provided them with the skills and knowledge they needed to do their jobs. Staff understood their role and what was expected of them. They told us the recent improvements made them happy in their work, motivated and confident in the way the service was managed.

We saw staff advising and supporting people in a way that maintained their privacy and dignity.

People told us their views and experiences were taken into account in the way the service was delivered.

People were able to discuss their health needs with staff and had regular contact with a range of healthcare professionals as needed.

People and their relatives felt able to report any concerns and said they were confident these would be dealt with.

Staff said communication in the home was very good and they felt able to talk to the managers' and make suggestions. There were meetings for people who used the service, relatives and staff where they could share ideas and good practice.

There was a new manager in place who was working in partnership with other professionals to improve the quality of the s

We carried out this inspection on 16 and 21 March 2016 and it was an unannounced inspection. This means the provider did not know we were going to carry out the inspection.

Our last full inspection of the home took place on 30 March and 2 April 2015 and we found the home to be in breach of regulations for person-centred care, safe care and treatment, good governance and staffing. Compliance actions were given for these breaches in regulation and the registered provider was told to make improvements. On this inspection we checked improvements the registered provider had made. We found there were still breaches in regulations, therefore sufficient improvements had not been made to meet regulations.

Broomcroft House is registered to provide accommodation for up to 87 older people who require nursing and/or personal care. The first floor of the home is for people who are living with dementia. At the time of our inspection there were 55 people living at Broomcroft House, 26 of whom were living on the first floor and 29 on the ground floor.

It is a condition of registration with the Care Quality Commission that the home has a registered manager in place. There was no registered manager in post at the time of this inspection but there was a person who managed the day to day running of the home. 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 previous registered manager had cancelled their registration on 14 October 2015 and the current manager had been managing the home since that date.

The systems in place for carrying out quality assurance of the service to assure the service were compliant with regulations, identifying areas for improvement and acting on them, had been ineffective in ensuring those improvements and compliance with regulations. This included having information available about how the service had responded to complaints and people’s experiences about the quality of care provided.

Care and treatment was not provided in a safe way for people by doing all that was possible to mitigate risks, including the safe storage of medicines that required refrigeration, having systems in place to protect people who may be at risk of avoidable harm from other people’s behaviour that also lived at the home, and people’s nutritional needs.

People and relatives we spoke with told us staff were caring and compassionate in their approach. We observed this for most staff when they were interacting with people, but found staff did not consistently treat people with respect and dignity.

Staff were not given appropriate support through regular supervision and appraisal.

Care records we looked at contained some personalised information, but they lacked information about people’s lives and achievements and engaging people in these in their daily life at the home.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take a

Two adult social care inspectors carried out this inspection. This was a scheduled inspection in addition to checking improvements had been made following concerns identified at our last inspection of 6 November 2013. During that inspection we established consent was not always being obtained appropriately where people lacked capacity to make decisions. As well as assessing whether improvements had been made in this area, the focus of the inspection was to answer five key questions; Is the service safe, effective, caring, responsive and well-led?

At the time of our inspection, 66 people were living at Broomcroft House nursing and residential home. We spoke with three people who used the service. Some people at the home were unable to communicate with us in a meaningful way so we undertook periods of observation. We also spoke with seven relatives, the registered manager, two nurses, one care worker and the cook. We reviewed records relating to the management of the home which included five care files, audits, staff rotas, and other relevant documentation.

Below is a summary of what we found. The summary describes what people we spoke with told us, what we observed and the records we looked at.

Is the service safe?

There were risk assessments in place where required for people using the service in relation to their support and care provision. These were reviewed and amended as necessary to ensure risks were mitigated, whilst still allowing independence, to ensure people’s safety in relation to their care and support.

There was a sufficient amount of staff on duty to meet people’s needs. Relatives told us they felt there were enough staff to meet people’s needs. Two people told us, “they [staff] always come if I use the buzzer, sometimes left at night, it’s to be expected but it’s not for long” and “they [staff] always come to me”.

Systems were in place to make sure the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Policies and procedures were in place to make sure unsafe practice was identified and people were protected. This reduced the risk to people and helped the service to continually improve.

Staff understanding of the MCA 2005 (Mental Capacity Act) and DoLS (Deprivation of Liberty Safeguards) was limited. DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty.

Where restrictions were in place, it was not clear that the least restrictive options had been considered. For example, there were no records to demonstrate whether a person had the capacity to make a decision about the restriction in place. Additionally, there were no records to show that a best interest meeting had been held to evidence that other less restrictive options had been considered prior to the restraint / restriction being put in place.

This meant that the home had not followed the MCA Code of Practice to ensure that least restrictive alternatives were considered prior to restraints such as gates being put in place to safeguard people.

Is the service effective?

People and their relatives were happy with the care they received and felt this was suitable for their needs. Staff knew people well and recognised what support people needed. Relatives we spoke with told us, “the home couldn’t have done any better for [my family member], she is a big success story” and “I think it’s fabulous here, it’s given me peace of mind”. No one we spoke with expressed any concerns with the care at the home.

People received a varied, well balanced diet and measures were in place to ensure people received adequate nutrition and hydration. Everyone we spoke with was complimentary about the food. One person said, “the food here is excellent, both chefs are very good”. The cook had information available about people’s dietary requirements to ensure suitable and appropriate nutrition was provided for people.

Is the service caring?

During our visit we saw care workers interacted positively and gave encouragement whilst supporting people. One person told us, “the carers are brilliant, everyone is so so kind and caring, we have a lot of fun too”. Relatives we spoke with said, “I think it’s excellent, staff are really caring”, “it’s very friendly here, as good care as you can get” and “most of the time we’re happy”.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Care plans were in place for each individual covering a number of areas including mobility, communication, nutrition, mental state and cognition. Information was reviewed regularly and in response to any change in needs. Updates and amendments were made where required. We saw contact with, and referrals to,other professionals had been made where necessary. Relatives we spoke with told us they were able to influence and be involved in reviews of their family member’s care and support.

The home employed activities co-ordinators and we saw activities taking place on the day of our inspection. Two relatives told us about their family member being supported by staff in the home to re-engage in a hobby they had enjoyed most of their life. They said staff also facilitated visits between their family member and a friend who lived on the other floor at the home. This demonstrated people were encouraged and supported to engage in stimulating activities and social interaction meaningful to them.

Is the service well-led?

The home worked with other agencies and services to make sure people received their care in a co-ordinated way.

There was a quality assurance system in place and records seen by us showed that shortfalls were identified with actions put in place to address these.

Questionnaires were issued to people in the home, relatives and staff in order to obtain their views. Feedback was also sought by way of regular meetings for staff, residents and relatives which provided a further forum for people to put forward their views.

Discussions on best practice, improved ways of working and incidents reviews were common throughout formal team meetings and informal discussions.

Where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements. It was not always demonstrated that decisions were made in people’s best interests in line with the Mental Capacity Act 2005 (MCA 2005).

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People told us,” Put good words down for the girls, they’re excellent”, “Very nice, like it here.” One relative said, “We have regular input into the care and assessments of our [family member].”

People told us, “I feel safer here than I did in my own home”, and “I feel safe here.” People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The home had an effective recruitment procedure in place that they followed.

There was an effective complaints system available. Complaints were acknowledged, investigated and the findings provided to the complainant.

The Chatsworth unit supported people who had dementia. We identified a number of concerns relating to care on this unit during our previous inspection and therefore spent the majority of our time observng the care, treatment and support on this unit.

Because people with dementia are not always able to tell us about their experiences, we used a formal way to observe people during our inspection. This is called the ‘Short Observational Framework for Inspection (SOFI). This involved us observing three people in the dining room of the Chatsworth unit for 45 minutes and recording people’s experiences at regular intervals. These observations enabled us to see how staff interacted with people and how care was provided.

We noted that staff interaction was minimal throughout this time. One person did not having any contact with staff for 30 minutes. This person spent a majority of the observation time with their head on the dining room table. Minimal staff interactions took place for the other two people. Whilst staff interactions were limited, staff treated people with respect and courtesy during the interactions we observed. The overall outcome of our SOFI observation was neutral; this meant that there were no observable signs of positive or negative mood for the people we observed.

We spoke with two people on the Hardwick unit. Each person told us that they received their medication on time and that there had never been any issues with this.

People living in the home have a range of needs. Some people were not able to tell us their experience of living at the home so we used a variety of formal and informal observation methods across both floors of the home in order to see people’s interactions with staff, and see how care was provided.

Our observations showed us that people received a good level of support with their personal care needs. We saw that staff at the home spoke to people in a kind and respectful way and had a clear knowledge of people’s individual likes and preferences.

People who were able to communicate told us that they were happy living at the home and with the care they received. One person told us, “staff are caring and very good.” Another person told us, “I never feel rushed; I tell them if I’m going out and they come in plenty of time to help me get ready” and, “the food is excellent, in fact sometimes we get far too much. There’s a cooked meal at lunchtime and in the evening, we can have sandwiches if we don’t want two cooked meals.”

One person told us that their bedroom was not routinely vacuumed and stated “no one ‘hoover’s’ unless I ask.”

We spoke with three relatives of people who used the service. One relative felt that the dementia unit of the home needed " a greater staff to resident ratio." Another relative was appreciative of the relatives meetings held within the home and told us, “they are useful, they make you feel included.”

One relative told us how that they had been involved in writing the care plan of their family member. They welcomed this involvement and appreciated that fact that the home regularly phoned to update them and inform them of any changes to their relative’s care.

Another relative was complementary about the way in which the home had been pro-active in developing a plan to reduce the risk of their family members anxieties and behaviours escalating. The relative told us that this had worked well and that their family member was much calmer and had been able to stay at the home.

This inspection took place on 30 March and 2 April 2015 and was unannounced. An unannounced inspection is where we attend the service without informing anyone beforehand. We last inspected this service in May 2014 and found that the service was not meeting the requirements of two of the regulations we inspected at that time. This was because the Mental Capacity Act 2005 was not always being adhered to in order to ensure people were not being deprived of their liberty inappropriately. Accurate records and documentation were not always maintained for people who used the service. An action plan was subsequently received setting out how the service intended to address these issues by November 2014.

Broomcroft House is registered to provide accommodation for up to 87 older people who require nursing and/or personal care. The first floor of the home meets the needs of people who are living with dementia. There were 61 people living at Broomcroft House at the time of our inspection.

There was a registered manager in place 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 registered manager understood Deprivation of Liberty Safeguards (DoLS) and applied for authorisations as needed, which we saw evidence of. However, we found that the arrangements in place for obtaining consent for decisions did not always consistently follow the principles of the Mental Capacity Act 2005 (MCA).

Medicines were not managed in a safe way. We saw that temperatures for the storage of medicines were not being regularly checked to ensure they were within a safe range. Medication records were not suitably checked to identify gaps and omissions.

Although staff were visible most times, there were some busy periods where there was a lack of staff to respond to people’s needs. Staff told us they sometimes struggled if they were short staffed and some care staff felt nursing staff could have more input in direct care provision.

People’s care records were reviewed regularly and contained information about people’s individual support requirements and preferences and how these were to be met. Individual risk assessments were in place in order to minimise and manage risks to people. However, we saw instances where care was not provided in accordance with people’s care plans.

Staff demonstrated knowledge of people’s preferences. They provided explanations to people and offered choice when providing support. People told us they were encouraged to be independent and were given choice. All people spoke positively about staff and we observed positive interactions between staff and people at the service. Relatives were equally complimentary about staff and positive about the care their family members received.

People at the service were supported to access healthcare and received assistance and treatment for their health needs. People’s nutritional preferences were accommodated.

An effective recruitment process was in place so that people were assessed as being suitable to work at the service. Staff undertook an induction on commencing employment at the home. Staff spoke positively about this and said it gave them a good grounding for their role.

The service employed two activities co-ordinators. We saw, and were told about, some activities that took place. However, there were periods of time where there was a lack of stimulation available for people.

Incidents that occurred were overseen by the manager and monitored for trends and themes to prevent reocurrence.

We found four 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.