Broome End

Broome End 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. The service accommodates 37 people, some of whom are living with dementia, in one adapted building. At the time of our inspection there were 27 people using the service.

Following our last inspection on 12 July 2017 the service was given a final rating of 'Requires Improvement'. A breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified because the provider failed to have effective systems in place to ensure people's medicines were stored and managed safely. Improvements were also needed in relation staffing levels, due to high reliance on agency resulting in people not being supported by staff that understood their needs and a lack of cohesion amongst staff. Limitations on staff time had meant that the care provided was largely task focussed, with little meaningful stimulation or interaction. We also identified that the governance and quality assurance systems were not effective and had not identified failings in the service, found at the inspection.

At this inspection we found significant improvements had been made. A new manager was in post and had registered with the Care Quality Commission (CQC) to manage the service. A registered manager like registered providers, 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.

Systems had been implemented which were used to continuously assess and monitor the quality of the service. The registered manager and staff had a clear understanding of what was needed to ensure the service continued to develop, and ensure people received high-quality care.

There were sufficient numbers of staff available to meet people's needs. Recruitment remained an issue for the service largely due to the rural location. However, three new care staff had been recruited, and a small pool of bank and regular agency staff were being used, to provide continuity. Since our last inspection a deputy manager had been recruited. Where previously the registered manager had been overseeing all aspects of the service, the additional resources had freed up their time to focus more on their managerial duties.

This service was selected to be part of our national review, looking at the quality of oral health care support for people living in care homes. The inspection team included a dental inspector who looked in detail at how well the service supported people with their oral health. This includes support with oral hygiene and access to dentists. We will publish our national report of our findings and recommendations in 2019. However, for this inspection we found oral health training for staff was basic. The deputy manager had taken

on the role of oral health champion and outlined plans to improve oral health care, including training. Champions are staff that have shown a specific interest in specific areas. They are essential in developing best practice, by sharing their leaning and acting as role models for other staff.

Staff felt supported by the management team, in particular the registered manager. Staff were encouraged to further their knowledge and skills through a combination of training methods, including eLearning as well as external trainers coming to the service. Staff's competencies had been assessed to ensure they had understood what they had learnt and were able to effectively apply it to their daily practice.

People were protected from risk of harm and staff had a good understanding of processes to keep people safe and how to report concerns. Safeguarding incidents were managed well. Peoples' medicines were being managed safely. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience, and were suitable to work with people who used the service. The deputy manager had engaged with the local authority Prosper scheme. This scheme is aimed at promoting new ways of reducing preventable harm from falls, urinary tract infections and pressure ulcers. The implementation of the Prosper programme, combined with the use of assisted technology, such as sensor matts, had clearly had an impact on reducing the number of falls, in the service.

Our previous inspection found, people's meal time experience varied according to which staff member was assisting them. At this inspection, whilst we found improvements had been made, there were isolated incidents where staff interaction was lacking, but the remainder of the meal time was seen to be a positive, and sociable experience. People were supported to eat and drink enough to maintain a balanced diet. People were supported to live healthier lives and had good access to healthcare services, where required.

Although, improvements to the premises had been made, through a programme of redecoration, further consideration in conjunction with good practice guidance was needed in relation to the suitability of the layout and living space in the dementia unit.

People, their relatives, friends and health professionals were complimentary about the attitude and capability of the staff, the registered manager and the care provided. The community matron, district nurse and a student nurse visiting the service during our inspection all commented that they had seen a great improvement in the service since the new manager came on board. Staff had developed good relationships with people using the service. Staff treated people with kindness, promoted their independence and respected their privacy and dignity.

People were supported to express their views and be actively involved in making decisions about their care. Consent to care and treatment was being managed and sought in line with legislation and guidance.

The provider was meeting the requirements of the Accessible Information Standards. This set of standards sets out the specific, approach for providers of health and social care to identify, record, share and meet the communication needs of people with a disability, impairment or sensory loss. People had access to a range of activities, depending on their interests, within the home and via external sources, and chose if they wanted to take part. Posters were displayed around the service advertising events and asking people for their suggestions and ideas. People were supported to follow their chosen faith and religious practices.

Systems were in place to ensure people's concerns and complaints were listened and responded to. Records showed complaints had been investigated in full and an apology provided to the complainant. Complaints had been used to improve the quality of the service. No one currently using the service was receiving end of their life care, however feedback from people's relatives in thank you cards and discussions

with staff confirmed people were supported to have a comfortable, dignified and pain-free death.

The five questions we ask about services and what we found