Bromley Park Dementia Nursing Home

We found the following examples of good practice.

Arrangements were in place for relatives to visit the home safely in line with national guidance. This included screened visits and PPE provided to visitors. People were supported to speak to their families on the phone or via video call. The provider had introduced virtual consultations to reduce the need for external visitors to the home.

The provider was following best practice guidance to ensure visitors inside the home did not introduce and spread Covid19.

The provider had arrangements in place to test both people and staff for COVID-19, in line with the current guidelines on testing.

The provider had clear protocols for people who were infected with COVID-19, and for people who had been admitted to the home from hospital or the community. Staff were adhering to PPE and social distancing guidance.

Staff who were more vulnerable to COVID-19 were supported and risk assessed to ensure staff and people remained safe.

The service had an experienced registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was aware of their legal requirement to display their current CQC rating which we saw was on display within the home and on the provider’s website.

At our last inspection of the service on 24 and 25 October 2017 we rated the service overall as 'Requires Improvement'. This was because although there had been considerable improvements to the service following our inspection in April 2017 where we found concerns and took enforcement actions, further improvements were required to ensure changes made were consistently embedded at the home over time. We also found a breach of regulation 12 as some changes in risks for some people had not always been identified, monitored or guidance provided to staff.

At this inspection we found continued improvements had been made across all key questions and the breach of Regulation 12 had been met.

Risks to people were identified, assessed and managed by staff to help keep people safe and well. Medicines were managed, administered and stored safely. People were protected from the risk of abuse, because staff were aware of the types of abuse and the action to take to ensure people’s safety and well-being. There were systems in place to ensure people were protected from the risk of infection and the home environment was clean and well maintained. Accidents and incidents were recorded, monitored and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs in a timely manner.

People’s needs and preferences were met by suitably skilled staff with the right knowledge and experience. There were systems in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. 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. People’s physical, mental and social needs were assessed before they moved into the home. The home environment was suitably maintained and adapted to meet people’s needs. People were supported to eat a well-balanced diet. People were supported to maintain their health and well-being.

People were supported to maintain relationships that were important to them. There were established and affectionate relationships between staff, people and their relatives. People were able to express their views, were involved in decisions about their day to day care and were provided with information about the service. People's privacy and dignity was respected and maintained.

People’s diverse needs were met and staff were committed to supporting people to meet their needs with regard to their disability, race, religion, sexual orientation and gender. People were involved in making decisions about their care. There was a range of activities available to meet people’s interests and needs. The service provided care and support to people at the end of their lives. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint.

There were well-led and effective systems in place to monitor the quality of the service provided. People’s views about the service were sought and considered. The provider worked in partnership with other agencies, charities, community initiatives and professionals to ensure people received appropriate levels of care and support to meet their needs and information and best practice was shared between agencies when appropriate.

Some incidents were brought to the attention of the local authority and clinical commissioning group (CCG), by the home and CQC during this inspection and a provider concerns process was put in place. The provider had placed a voluntary restriction on new admissions during this period

We had served a warning notice in respect of the more serious breaches found in relation to the governance of the home. We had carried out a focused inspection on 25 and 26 July 2017 to check that improvements to these more serious concerns had been addressed. We found some improvements had been made.

We carried out this inspection in line with our special measures guidance and to check that sufficient progress had been made to reduce risks and meet all the fundamental standards.

Bromley Park Dementia Nursing Home is a care home that specialises in care and support for people living with dementia. 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 care home can accommodate up to 50 people in one adapted building. At the time of the inspection there were 27 people living at the home.

There was a registered manager in post and a new manager had just come to work at 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.

There had been a considerable amount of change required. At this inspection on 24 and 25 October 2017 we found considerable improvements had been made across all key questions.

However, there remained some room for improvement to ensure the changes were consistently embedded at the home over time. We found that most risks to people were identified assessed and monitored well. However, we found a breach of regulation as some changes in risk for some people had not always been identified or monitored or guidance provided to staff. For example the need for a call bell had not been identified for one person or the need for a wound care plan for another person. You can see the action we have asked the provider to take at the back of the full version of this report.

Records related to risk had improved and the registered manager was working to monitor and ensure improvements became embedded. Care plans needed some improvement to ensure accuracy and that people’s needs were reflected consistently in the care plan.

Leadership at the home had improved significantly and we found this had improved outcomes for people. Most people could not express a view about their care but feedback we received from relatives, visitors and professionals confirmed that they had noticed considerable improvements to the quality of care provided. We observed the culture of the home had changed and care was now more directed by the needs of people and the aim to provide personalised care. There was a range of meetings to ensure effective communication between staff at the home and people’s views were sought through regular residents and relatives meetings and surveys.

There were significant improvements to people’s care. People and their relatives told us they felt safe and well cared for. Staff knew how to identify and respond to any safeguarding concerns. We saw people felt comfortable in staff presence and interactions were positive. Medicines were safely managed. There were now enough staff to meet people’s needs and there had been a significant increase in permanent staff. Recruitment processes were effective to ensure suitable staff were recruited.

Improvements had been made to staff training and development through champion and senior care worker roles.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Improvements had been made to the way people’s dietary needs were met and a range of health professionals were available to support their health needs.

People and their relatives told us they were treated with dignity and respect and they were now more involved in their care planning. Complaints were managed appropriately.

There were some very good elements to the care provided. Non-care staff were seen to interact with people in a warm and knowledgeable way. There was a wide range of activities provided that engaged people and the activities coordinators promoted personalised sensitive care.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the comprehensive inspection in April 2017 we had found serious breaches of regulations around the governance of the home. This had impacted on the safe running of the home and the systems used to assess and monitor risk which had negatively affected people's care and safety. The provider’s quality assurance checks had not been effective at identifying the concerns we found. We took enforcement action and served a Warning Notice which told the provider to meet legal requirements in respect of the regulation breached by 5 June 2017. The home was rated Inadequate overall and was placed in special measures. We had discussed our concerns with the provider and manager at the time; the provider had voluntarily agreed to impose their own embargo on new admissions during the inspection and this remained in place at this inspection.

Following our inspection we had raised concerns about our findings with the local authority and Clinical Commissioning Group. A number of safeguarding alerts were raised in relation to people’s care; these were under investigation by the local authority at the time of this inspection. The local authority had also imposed an embargo on new admissions to the home on 5 May 2017; this also remained in place.

This report only covers our findings in relation to the more serious breaches identified at our last inspection and in our warning notice. You can read the report from our last comprehensive inspection, by selecting the link for Bromley Park on our website at www.cqc.org.uk. Other breaches of regulations were found at the comprehensive inspection in April 2017 in relation to medicines management, following safeguarding processes, person centred care, staff training and staffing levels. We served requirement actions and the provider sent us an action plan in respect of these breaches. This will be followed up at the next comprehensive inspection which, because the home is in special measures will take place within six months of the publication date of the report from the comprehensive inspection in April 2017.

Bromley Park Dementia Nursing Home is registered to provide accommodation and nursing care for up to 50 people living with dementia. On the day of the inspection there were 33 people using the service.

There was no registered manager in post at this inspection. There had been a number of managers at the home since the departure of the previous registered manager in October 2016. At the time of the last comprehensive inspection in April 2017 a new manager had recently started at the home; however, they left the home at the end of May 2017. The provider’s practice development manager had become the manager of Bromley Park at the beginning of June 2017. They were in the process of submitting an application to register as manager with the 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.’

At this inspection we looked at the action taken to address the more significant breaches of regulation we had identified in the Warning Notice served on the provider following the last inspection. Relatives told us they felt there had been changes for the better. We found improvements had been made to the systems of identifying, assessing and monitoring risk and there were improvements in the governance at the home. There was a range of protocols in place to guide nurses about the actions to take in response to sudden deterioration in people’s conditions. Audits were carried out to monitor people’s clinical care to track that relevant actions were taken and any identified learning could be provided to staff. Care following an accident or incident was tracked to ensure all necessary actions were taken. Improvements had been made to the monitoring of people nursed in bed.

Improvements had been made to the systems to track nutritional needs and weight loss and to inform the kitchen staff of people’s dietary needs.

The system to monitor equipment and the safety of the premises had improved and a system of regular checks was now in place. However, we have recommended that the provider refers to current guidance and seeks advice from a reputable source to ensure there is a robust legionella risk assessment available for future inspection in line with current guidance.

Improvements were needed to ensure the processes described above were routinely and consistently followed and they needed time to fully embed. We will check on this improvement at our next inspection.

The home remains Inadequate in safe. This is because although there have been improvements there are three outstanding breaches in this key question identified at our last comprehensive inspection in April 2017. The key question safe meets with the characteristics of Inadequate, and, these breaches will be followed up at the next comprehensive inspection. We found sufficient improvements to change the rating of the key question well led to Requires Improvement because our findings evidenced that it meets the characteristics for this rating. The overall rating is now Requires Improvement in line with our characteristics for awarding ratings. We will continue to monitor improvements closely as the home remains in special measures.

Bromley Park Dementia Nursing Home is registered to provide accommodation and nursing care for up to 50 people with dementia. On the day of the inspection there were 37 people using the service. Since the last inspection there had been some changes in the management team at the home. At the time of this inspection there was no registered manager or deputy manager in place. The previous registered manager had left the home in October 2016. A new manager had been appointed and had left in January 2017. Another new manager had been appointed and had just started work at the home in March 2017. 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 this inspection we found considerable concerns about the systems used to assess and monitor risk which had impacted negatively on people’s care. Quality assurance checks were not effective at identifying the concerns we found. We identified problems that had arisen prior to the new manager’s arrival which impacted on the current safe running of the home. We found a serious breaches of regulations around the governance of the home. Following our inspection we raised concerns about our findings with the local authority and CCG.

The provider’s systems had not always alerted them to the concerns we found. However, during the inspection the manager and operations manager took prompt action to address the more serious risks we found. The provider and manager were open about the concerns and issues found, and demonstrated a commitment to address them promptly and effectively. The manager had identified some issues since starting work at the service, in particular about medicines management and staff competency. We saw that they had already taken some action to address the concerns; however we were unsure that these had been embedded into staff practice. Following the inspection the provider sent us an action plan which included a system of support for the manager to ensure they could start to embed good practice across the home.

We also found further breaches of regulations as people were not always protected from neglect, some areas of medicines management, such as medicines that may need to be administered covertly, were not safely managed. Other areas of risk to people were not always assessed or action taken to reduce risk. There were not always enough staff to meet people’s needs and staff did not always have sufficient training to be able to meet people’s need safely. Care plans had been recently reviewed; however, they were not always reflective of people’s needs and staff were not always aware of what people’s current needs were. People or their relatives told us they were not always involved in the planning of their care. You can see the action we have asked the provider to take in respect of these breaches at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There were areas for improvement as we observed that people were not always treated with sufficient dignity and respect.

The overall rating for this service is ‘Inadequate’ and the service is therefore ‘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 may take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we could take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

We also found there were some good elements to the care provided at the service. People and their relatives told us that staff were kind and caring and knew people well. We saw some warm and friendly interactions between people and staff across the home. People were observed to be clean and well presented.

People had access to a suitable range of health care professionals and two health professionals gave us positive feedback about their contact with the home. Staff sought consent from people when offering them support. The home followed the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), where people had been assessed as lacking capacity to make certain decisions about their care and treatment.

There was a complaints system readily available and responses had been made in line with the provider’s policy. Annual surveys and relatives and residents meetings were held to capture people’s experiences of care and views about the home and the care provided.

We observed that people were treated with dignity and respect and where possible were involved in their care. Where this was not possible relatives told us they were involved with care planning and were given adequate information about the service. The care was planned and delivered in a way that met people's needs. Risk assessments and care plans were individualised and mostly reflected people's needs. The provider responded to any concerns raised promptly and liaised with other healthcare professionals appropriately. Staff were recruited in line with the providers policies and there were systems in place to protect people from the risk of abuse.