Background to this inspection
Updated
5 January 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection visit was carried out by 3 inspectors and 1 Expert by Experience. An Expert by Experience is someone who has experience of using this type of service.
Service and service type
Bromson Hill is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bromson Hill is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post. The registered manager was leaving at the end of November 2022. The provider had recruited a new manager who would make an application to be registered with us once they joined the service in December 2022.
Notice of inspection
This inspection visit was unannounced.
What we did before inspection
We reviewed the information we held, such as people and relatives’ feedback and notifications that the provider is legally required to submit to us for notifiable events. We reviewed information shared with us by the local authority and clinical commissioning group. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 7 people who received a service to get their experiences about the quality of care received. We also spoke with 2 relatives whose family members received a service. We spoke with 3 members of care staff, plus a deputy manager, a cook, a housekeeper and the registered manager. We spent time observing people and staff practice.
We reviewed a range of records. This included examples of 8 people’s care records and samples of medicine records and associated records of their care. We looked at records that related to the management and quality assurance of the service, fire safety and environmental risks and records for infection control and risk management. We reviewed 2 staff recruitment files.
Updated
5 January 2023
About the service
Bromson Hill is registered to provide accommodation, nursing and personal care for up to 34 older people, including people with dementia. At the time of our visit there were 18 people living at the home.
Bromson Hill is an adapted building with care and support provided across two floors. A communal lounge and dining area are located on the ground floor. Some people’s bedrooms were ensuite and there were further communal bathroom facilities located on each floor. People could access both floors of the home via a lift or staircase.
People's experience of using this service and what we found
At our last inspection, we found some improvements were required as health risks were not always updated and reviewed. We identified a breach of the regulations.
Following the last inspection, we formally requested that the provider sent us a monthly action plan telling us what they had improved and where improvements continued to be made at the service, with timescales.
At this inspection, we found the action plan had driven some improvements and some risks associated with people’s care were managed safely. Audits had been improved with actions taken to address areas identified as requiring improvement. This meant the provider was no longer in breach.
However, improvement and further time was still needed in some areas to ensure new audits and processes were fully embedded into everyday practice. Risks for some people who required regular repositioning needed better oversight to ensure they were repositioned regularly. People who needed topical creams did not always have these applied in line with the manufacturer’s guidelines. Systems of audits although improved, had not identified some of the improvement actions we found at this visit.
Overall, people and relatives were complimentary of staff. Staff told us they knew people and we saw during our visit, staff responded to situations to help promote good care outcomes.
Reliance on agency staff was no longer paramount as the provider had recruited more staff since our last visit. We saw staff spent time with people which helped develop supportive relationships. Most people spent their time in bed or in their own rooms. Some people felt staff response times were not always as prompt as they would like.
People were safe because staff understood their responsibility to report any concerns to protect people from the risk of abuse.
Staff continued to receive training in key areas and staff said they felt supported which helped increase their knowledge and confidence.
Competency checks were completed for staff who administered medicines to ensure staff administered medicines safely.
Infection control systems ensured the home was clean. Housekeeping staff supported the home and all staff wore personal protective equipment to help minimise the risk of cross infection. Maintenance and regular environmental checks on health and safety helped ensure the home remained safe for people.
Families and external health visitors were welcomed. Relatives told us they had to continue to book appointments to visit family members. We referred the registered manager to the latest government guidance about family visits.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 30 July 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last four consecutive inspections.
Why we inspected
This inspection was prompted by a review of the information we held about this service and to check the provider had improved certain areas identified at our last visit.
This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bromson Hill on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information, we may inspect sooner.