CQC report explained · a nursing home
What the CQC found at Broxbourne Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- People generally felt safe and staffing, safeguarding and infection control had improved. However, inspectors found a missed as-needed medicine, one pressure mattress set incorrectly and food choices that did not always reduce diabetes-related risks.
- Effective?
- Good
- People's needs were assessed before admission and staff had suitable training. The home followed the Mental Capacity Act and supported people to eat, drink and access health professionals, although condiments were not always available.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff knew people well, offered choices and involved people in decisions about their care.
- Responsive?
- Good
- Care plans were detailed and reflected people's preferences and needs. Activities and communication support were available, but some relatives reported occasional communication difficulties and mixed views about whether activities were sufficiently stimulating.
- Well-led?
- Good
- Management and governance had improved significantly. Audits, checks, meetings and feedback systems were in place, and the home had acted on the previous inspection findings.
What inspectors found, October 2023
Broxbourne Nursing Home was rated Good overall and is no longer in special measures, but Safe Requires Improvement.
This was an unannounced follow-up inspection. One inspector visited on 15 August 2023 and reviewed care records, medicines, staffing, training, incidents and quality checks. The inspection activity continued until 7 September 2023.
Inspectors found clear improvements since the previous inspection, which had rated the home Inadequate. People and relatives said they felt safe and were happy with the care. Staff were described as kind, respectful and familiar with people's needs.
There were still safety issues. These included a missed as-needed medicine, one pressure mattress set incorrectly and concerns about food for a person with diabetes. The home was rated Good overall, but Safe was rated Requires Improvement. The home was no longer in breach of regulations or in special measures.
Kind and respectful care
People were supported patiently and respectfully. Staff knew people's routines, preferences and needs.
“Staff respected people's privacy and dignity. They knew their routines to ensure privacy was not disturbed.” from the report
Improved leadership
Inspectors found better oversight, more effective checks and a stronger culture in the home.
“There had been a significant improvement to the culture in the home and the use of governance systems.” from the report
Staffing and training
People received timely support and staff had relevant training. The home had reduced its use of agency staff and had a plan for changing staffing needs.
“We saw staff were available when people needed and they responded promptly.” from the report
Personalised care and activities
Care plans reflected people's choices and interests. Inspectors saw people taking part in activities and using communal areas and the garden.
“We reviewed people's care plans and saw they were supported in their chosen way.” from the report
As-needed medicines
seriousA recent incident involved an as-needed medicine not being given when the person's health needs changed. The home provided further training and changed its audit system.
“However there had been a recent incident where medicines prescribed 'as needed' had not been given when the person's health needs changed.” from the report
Pressure mattress checks
seriousOne mattress checked was set incorrectly for a person who had a pressure ulcer. The management team carried out further checks and staff observations after the visit.
“However, of the mattresses we checked, 1 was set incorrectly for a person.” from the report
Food and diabetes risks
seriousFood eaten by a person with unstable diabetes did not always reduce the associated risks. The home said alternatives, discussions and extra training were being provided.
“However, for a person who was diabetic, the food eaten did not always reduce the risks associated with this.” from the report
Communication difficulties
needs fixingSome relatives said that accents and language differences sometimes made it harder for people to hear or understand staff. The home had introduced extra language and communication training.
“However, some relatives told us that there was a communication barrier at times as some staff did not have English as their first language” from the report
Infection control detail
minorSome staff were wearing nail polish or nail extensions, which inspectors said could increase the risk of ineffective hand hygiene. The manager said this would be addressed.
“However, we did note that some staff had nail polish and or nail extensions on which increases the risk of cross infection due to risk of ineffective hand hygiene.” from the report
- 01How do you now make sure as-needed medicines are given promptly when a person's health needs change?
- 02How often are pressure mattresses checked, who records the checks, and what happens if a mattress is set incorrectly?
- 03How do you manage food choices for people with diabetes, especially where the person does not understand the risks?
- 04What support and monitoring are in place to make sure staff communicate clearly with people who have difficulty hearing or understanding accents?
- 05How do you check that activities are suitable for people with dementia and for people who spend much of their time in their rooms?
This was an unannounced follow-up inspection checking action from the previous inspection, including a Warning Notice about governance and infection prevention and control; the inspection re-rated all five key questions. This explanation was written from the published report of 6 October 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2023
Rated Inadequate and placed in special measures; inspectors found serious risks in safeguarding, care planning, staffing and management.
This was the home's first inspection. It was unannounced and took place on 8, 16 and 25 November 2022. Inspectors spoke with people, relatives, staff and visiting health professionals. They reviewed care records, medicines, staff files, accident records, complaints and management checks.
Inspectors found people were at risk of avoidable harm. Safeguarding concerns were not always reported or investigated properly. Care plans and risk assessments were incomplete. Staff did not always have the training, practical skills or support needed, especially for dementia care. Some people were bored because there were few meaningful activities.
The home also had problems with consent, personalised care, infection control and openness when things went wrong. Inspectors found that leaders did not have effective oversight of the service. The home breached seven regulations, including safe care and treatment, safeguarding, staffing, consent, person-centred care, duty of candour and good governance, as well as a separate registration regulation about notifications.
The provider stopped new admissions, increased staffing and started a service improvement plan during the inspection. The overall rating was Inadequate, so the home was placed in special measures and will be closely monitored.
Kind interactions
People and relatives said staff were kind and caring. Inspectors also saw staff treating people with kindness and respect.
“We observed staff treating people with kindness and respect when talking to them.” from the report
Medicines records
People received their medicines as prescribed. Records and protocols gave staff enough information about medicines given when needed, and medicines systems helped identify errors.
“People's care plans and protocols contained sufficient information to support staff to administer 'when required' medicines (PRN).” from the report
Safe permanent recruitment
Permanent staff recruitment included checks of criminal record information and identity or immigration documents where relevant.
“Permanent staff were recruited in a safe manner, including obtaining Disclosure and Barring Service (DBS) checks” from the report
Accessible building
The newly built home was well maintained and accessible. Communal areas were spacious and included several facilities for people and visitors.
“The environment was newly built, well maintained and fully accessible.” from the report
Safeguarding failures
seriousSome safeguarding concerns, injuries and incidents between people were not reported to the local authority or the CQC, and were not fully investigated. This left people at risk of harm.
“Failure to ensure safeguarding concerns were reviewed, investigated and reported appropriately left people at risk of harm.” from the report
Incomplete risk planning
seriousCare plans and risk assessments did not consistently explain how to manage falls, wounds, diabetes, pressure ulcers or distress related to dementia. Staff did not always follow specialist advice.
“The registered manager and provider failed to ensure all risk assessments were in place and measures to mitigate risk were detailed to help staff keep people safe.” from the report
Staff skills and checks
seriousAgency staff records did not show that appropriate training and checks had been completed. Staff did not receive enough practical training, supervision or competency assessment.
“Staff were not supported to develop their knowledge or reflect on their practice, and they did not all have the appropriate knowledge, skills, or training to provide safe and effective care.” from the report
Poor personalised care
seriousPeople's likes, dislikes and care needs were not reliably reflected in practice. Inspectors found limited activities, including one person who had not had a shower for four weeks.
“People were not receiving personalised care and support.” from the report
Consent and restrictions
seriousMental capacity assessments and best interest decisions were incomplete. Some restrictive support and sharing of personal information with relatives were not properly authorised.
“This was a breach of Regulation 11, need for consent, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Weak leadership
seriousThe provider's audits and governance systems did not identify or control important risks. The registered manager was removed from the home during the inspection, with interim managers taking over.
“Systems were not effectively operated to ensure people received safe and appropriate care.” from the report
- 01What improvements have been made to safeguarding investigations and reporting since the inspection?
- 02How do you now check that each person's care plan and risk assessment gives staff clear, individual instructions?
- 03What practical dementia, moving and handling, clinical and competency training have staff completed, including agency staff?
- 04How are activities planned around each person's interests, and how do you check that preferences are followed in daily care?
- 05What action has been taken following the warning notice, and what evidence can you show of progress?
This was the home's first full inspection and covered all five key questions, including infection prevention and control; there were no previous ratings to carry forward. This explanation was written from the published report of 12 January 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Broxbourne Nursing Home
2 rated inspections over a year: the service has improved, from Inadequate to Good.
- October 2023Goodcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2023InadequateSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- June 2022
Registered with the Care Quality Commission on 9 June 2022.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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