Bromson Hill Care Home

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.

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 inspection visit there were 22 people living at the home. Care is 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's experience of using this service and what we found

At our last inspection, we found concerns related to the risk management of people’s health and welfare, medicine management and effective oversight of the service, did not meet the regulations. In response to our last inspection, the provider sent us an action plan telling us how they had strengthened their audit processes and would better address risk management. The new processes would be managed by a new manager to the home to ensure standards and managerial oversight were improved, sustained and that they improved standards of care and quality at Bromson Hill.

At this inspection, we found some systems of governance had been implemented and some areas of risk had been partially improved. However, the provider’s systems were not yet effective and established because they had not identified all the improvements required. This was because the systems effectiveness and how they were embedded in day to day practice required more time to develop.

Some areas previously identified as a concern at the last visit remained, which meant some people continued to be exposed to the potential for harm. Care plans that had been completed to a ‘new standard’ continued to fall short of requirements. Audits had not identified this. We also found some newly implemented medicines checks did not cover all aspects of safe medicines management.

Other newly implemented audits needed further improvement because some were a tick box to show a check was completed rather than identifying and improving what was required. We acknowledge some improvement was made by the new manager; however, we could not be confident the provider had learnt lessons as similar issues repeated themselves. This showed us lessons had not always being learnt because the same issues remained from the previous inspections.

Infection control systems implemented during a pandemic were in place. However, as health professional visitors, on the first day, the inspection team were not all checked to ensure we were negative of COVID-19 and temperature checks were not always completed in line with the provider’s management processes.

People’s overall feedback to us was mainly positive of a service they received that they felt met their needs. However, we found care plans, care plan reviews and risks associated with some people’s care were either not recorded, not updated or were not followed or consistently understood by the staff team. Staff conversations about the people they looked after and how they needed to be cared for, were inconsistent.

Staff understood their responsibility to report any concerns to protect people from the risk of abuse.

Staff were positive about the new manager and the work the manager had put in to improve the quality of care people received. Staff had received training in key areas such as fire safety and first aid. However, some additional training for staff who maintained and checked fire safety, needed improvement.

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 inadequate (published 29 April 2022) and there were breaches of regulation. This service has been in Special Measures since 17 February 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

The provider had received warning notices following the last inspection and they had to be compliant with these. The provider was also required to send us an action plan telling us how they would improve and by when. At this inspection enough improvement had been made against regulation 12 and the warning notice and regulation was met. However, the regulation 17 warning notice was not met. This meant the provider continued to be in breach of this regulation.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. 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 changed from inadequate to 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 Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will send the provider a formal letter requesting an action plan to understand what they will do to further improve their quality assurance systems. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bromson Hill Care Home provides nursing care to a maximum of 34 older people, younger adults and people who may have a physical disability. At the time of our visit 27 people lived in the home.

People's experience of using this service

People's individual risks were not always identified, assessed and well-managed. The provider could not demonstrate all planned care had been provided safely because records were not always completed accurately or clearly to demonstrate safe practice and enable effective monitoring to take place.

Some environmental hazards which posed a risk to people, staff and visitors to the home had not been identified.

Medicines were not always stored securely, and staff did not consistently follow nationally recognised guidance to ensure medicines were managed safely.

At the time of our inspection visit there were enough staff on duty to meet people's needs, but there was a reliance on agency staff to ensure safe staffing levels were maintained. The staffing arrangements did not ensure the staff team always had the right mix of experience and skills to meet people’s needs safely and effectively. Following our inspection, the provider explained the actions they had taken and those planned to try to address staffing challenges.

The provider was not consistently acting in accordance with up to date guidance to minimise the risks of infections spreading.

Audit processes had failed to identify areas needing improvement which placed people at unnecessary risk.

At the time of our inspection, the registered manager was absent from the service on extended planned leave and there was no deputy manager. The permanent registered nurse was providing interim managerial cover and was on call to provide support to the service 24 hours a day, seven days a week. These arrangements were not sustainable.

The provider had failed to provide effective support for the interim manager or to maintain sufficient and accurate oversight of the service. This meant risk management was ineffective and that regulations were not being met.

Following our feedback, the provider implemented an action plan to improve standards and practice at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 5 August 2019).

Why we inspected

The inspection was prompted in part due to information received about staffing levels in the home and the management of risk within the service. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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.

The overall rating for the service is now inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bromson Hill Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches of regulations in relation to safe care and treatment and good governance at this inspection. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bromson Hill Care Home provides nursing care to a maximum of 34 older people, younger adults and people who may have a physical disability. At the time of our visit 27 people lived in the home.

People’s experience of using this service:

Risks to people’s health and wellbeing had been assessed and records confirmed that care staff followed care plans to minimise identified risks. Health professionals were contacted where appropriate to support people’s healthcare needs. However, improvements were required to minimise risks posed within the environment. A more robust system was required for recording and monitoring accidents and incidents.

There were enough staff available with the appropriate knowledge and skills to meet people’s needs. People felt safe living at the home and the staff team had received training on the safeguarding of adults.

People's needs were assessed before moving to live at Bromson Hill and care plans provided guidance to enable staff to provide effective treatment and support. People received their medicines when they needed them by trained staff. People's nutrition and hydration needs were met.

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. However, improvements were required to ensure information was presented to people in a way that supported them to be fully involved in their care.

People told us staff treated them in a kind and caring way and interactions between staff and people were mostly caring and respectful. However, we observed some interactions that did not demonstrate such a caring approach.

Care plans were comprehensive, but task focussed rather than reflecting people’s individual preferences for how they wished their care and support to be delivered. Despite this, people felt that staff knew them well. People had access to some social activities to maintain their well-being but some said there was not enough social stimulation for them.

People, relatives and staff were asked to give feedback about the quality of the service. However, audit checks completed to monitor the quality and safety of the service had not been consistently effective in identifying risk and areas needing improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service met the characteristics for a rating of “requires improvement” in four of the key questions we inspected. Therefore, our overall rating for the service after this inspection was “requires improvement”.

Rating at last inspection: At the last inspection the service was rated ‘Good’ overall. (Last report published 13 January 2017).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all information we receive about the service and schedule the next inspection accordingly.

A requirement of the service’s registration is that they have a registered manager. 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 and associated Regulations about how the service is run. There was not a registered manager in post at the time of our inspection visit. The previous registered manager had left the service several months before our inspection; a new manager had been appointed and had been in post for eight weeks. They intended to apply for registration as soon as their probation period had ended. We refer to the newly appointed manager as the manager in the body of this report.

People received medicines as prescribed to maintain their health and wellbeing. People were supported to access healthcare from a range of professionals inside and outside the home and received support with their nutritional needs. This assisted them to maintain their health.

People were protected against the risk of abuse as the provider took appropriate steps to recruit staff of good character, and staff knew how to protect people from harm. Safeguarding concerns were investigated and responded to in a timely way to ensure people were supported safely.

There were enough trained and supervised staff to care for people effectively and safely, and meet people's individual needs.

People were supported to access healthcare from a range of professionals inside and outside the home and received support with their nutritional needs. This assisted them to maintain their health.

The provider, manager and staff understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The manager had made applications to the local authority where people’s freedom was restricted, in accordance with DoLS and the MCA requirements. Decisions were made in people’s ‘best interests’ where they could not make decisions for themselves.

Staff knew people well and could describe people’s care and support needs. Staff treated people with respect and dignity, and supported people to maintain their privacy and independence.

Care staff treated people with respect and dignity, and supported people to maintain their privacy and independence. People made choices about who visited them at the home. This helped people maintain personal relationships with family and friends who were important to them.

Care records were up to date and provided staff with the information they needed to support people responsively. People were supported to take part in social activities and pursue their interests and hobbies.

People knew how to make a complaint if they needed to. Complaints received were investigated and analysed so that the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run.

Quality assurance procedures were in place to identify where the service needed to make changes; where issues or improvements were identified the manager took action to continuously improve the service.

Bromson Hill is divided into two separate floors and provides personal and nursing care for up to 32 older people, including people living with dementia. There were 28 people living at the home when we inspected the service.

A requirement of the service’s registration is that they have a registered manager. 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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection. We refer to the registered manager as the manager in the body of this report.

A full record of each person's individual care and support needs was not maintained. People's care records did not reflect the care and support they received from staff on a daily basis. However, permanent staff knew people well and could describe people’s care and support needs. Improvements were being made to the checking of care records to ensure they were kept up to date in the future.

People received medicines to maintain their health and wellbeing. The latest guidance on the administration of certain medicines needed improvement to ensure people received their medicines safely. People were supported to access healthcare from a range of professionals inside and outside the home and received support with their nutritional needs. This assisted them to maintain their health.

People were protected against the risk of abuse as the provider took appropriate steps to recruit staff of good character, and staff knew how to protect people from harm. Safeguarding concerns were investigated and responded to in a timely way to ensure people were supported safely. There were enough staff to care for people effectively and safely, and meet people's individual needs.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Decisions were made in people’s ‘best interests’ where they could not make decisions for themselves.

Care staff treated people with respect and dignity, and supported people to maintain their privacy and independence. People made choices about who visited them at the home. This helped people maintain personal relationships with people that were important to them.

People knew how to make a complaint if they needed to. Complaints received were fully investigated and analysed so that the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run. Quality assurance procedures identified where the service needed to make improvements, and where issues had been identified the manager took action to continuously improve the service.