This unannounced inspection took place on Wednesday 6 July 2016. The Broughtons provides residential care for up to 39 elderly people. The home is a detached building, situated in a residential area of Salford and is close to local shops and public transport. Parking facilities are available to the front and side of the building.
At our last inspection of The Broughtons on 30 September 2014, we found the home was meeting all of the standards assessed.
During this inspection we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment (two parts), staffing (two parts), person centred care, dignity and respect, safeguarding and good governance. You can see what action we have asked the home to take at the back of the report.
People living at the home told us they felt safe as a result of the care they received. Staff also displayed a good understanding of safeguarding and how they would report concerns.
We found staff were recruited safely, with appropriate checks undertaken before staff started working at the home.
We found medication was not handled safely. There were no photographs of people on their Medication Administration Records (MAR’s), to reduce the risk of confusion and ensure medicines were given to the correct person. We also found there were no cream charts in place, to demonstrate when creams were applied and to what areas of the body.
We found there wasn’t always sufficient staff with the correct skills to look after people living at the home at night. On the night of 5 July 2016, one person had asked for pain relief during the night, however there were no trained staff on shift to administer this safely.
People had risk assessments in their care plans covering areas such as mobility, nutrition and pressure sores, however we found these were out of date and needed to be reviewed. Risk assessments were also not reviewed following accidents and incidents.
We observed one person who was at risk of skin breakdown and needed to be sat on a pressure relieving cushion wasn’t sat on one during the inspection, despite raising this with a member of staff.
The environment was not consistently safe. When we arrived at the home and throughout the day, we saw tools such as a power drill and saw had been left unattended in a bedroom which was being refurbished. This increased the risk of people accessing the tools in an unsafe manner, placing people a risk.
Staff told us they received enough training and felt well supported. However two members of staff we spoke with felt they had not been provided with sufficient training and induction since working at the home, yet had been expected to oversee the home in the absence of the home manager. This included being provided with training such as moving and handling.
Staff told us they received supervision at regular intervals from their line manager. We saw records to confirm these had taken place.
We saw the environment at the home was not dementia friendly, with little signage around the building to help people orientate themselves around the building and establish where they needed to go.
We saw restrictive practice in operation at the home. For example, one person’s cigarettes were kept on a trolley which the staff dispensed at certain intervals. We could not find a capacity assessment, restrictive screening tool or evidence that a best interest meeting had been convened regarding this practice in the person’s file.
The people living at the home and their relatives told us they were happy with the care provided. They told us staff were kind and caring.
We saw instances where the privacy and dignity of people living at the home was compromised. On arrival at the premises we saw that people’s underwear was hung over the handrails in the corridors outside their bedrooms. Another person used a urine bottle in their bedroom, however this was left on display, with this person also telling us staff did not always empty it in a timely manner. We also observed this person had baked beans on their clothing, approximately two hours after eating their lunch.
We identified one person living at the home, who did not have a care plan in place, despite living at the home for several weeks. The other care plans we looked at were not updated and reviewed at regular intervals. The care plans we looked at also did not contain photographs of each person. This would make it easier for staff to identify the correct people when delivering care. Two visiting relatives also said they didn’t feel involved in the care of their family member.
We saw complaints were handled appropriately. The service also maintained a record of compliments, made by family members and relatives.
The home employed an activities coordinator and we saw people taking part in an activity during the inspection.
On the day of the inspection, the home manager was not present. Two care co-ordinators had been tasked with overseeing the home in their absence. We observed there to be a lack of visible leadership on the day of the inspection. For example, in communal areas we saw people weren’t always seated into chairs safely and sat on appropriate pressure relieving cushions. There was nobody overseeing that these tasks were completed correctly by staff, with the co-ordinators predominantly based in the reception area and the senior carer undertaking a medication round for large parts of the day.
The manager undertook audits of areas such as care plans, medication and the environment. The provider also undertook regular audits to ensure high standards were being maintained. However, we questioned the effectiveness of these given they did not highlight the concerns we had identified such as a lack of care plan and risk assessment updates, missing life history information and no cream charts being in use.
One member of staff told us an open and transparent culture was not promoted at the home and that if staff caused a problem for the home during a CQC inspection, that they would be ‘Found out’.
The home had a range of policies and procedures in place which provided staff with guidance and advice about various systems and processes to follow.
We saw minutes from recent team meetings, where staff told us they felt able to raise concerns and contribute towards discussions.