Bromson Hill Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People's needs were assessed and care plans were regularly reviewed. However, information within care records was not always, sufficiently detailed, accurate and up to date. This meant staff could not always rely on care records to provide clear and accurate guidance about people's needs.

For example, 1 person's skin integrity care plan had been amended following the removal of their catheter, but elements of their continence care plan continued to refer to them as having a catheter in place. This created a risk staff could follow outdated information.

Another person's nutritional care plan stated they were receiving palliative care, and staff should focus on ‘comfort rather than nutritional intake.’ However, the registered manager told us this information was no longer correct, and the person should be actively encouraged to eat.

A third person's nutritional care plan stated they had experienced weight loss and required fortified foods, yet weight monitoring records showed their weight had remained stable. The registered manager was unable to explain why this information remained within the care plan.

Care plans had been reviewed. However, some reviews had not identified the inaccuracies in information we found. This meant staff did not always have the information they needed to deliver care in line with people’s changing circumstance.
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People did not always receive care that was fully supported by accurate, up-to-date, and evidence-based documentation. There was a lack of understanding across managers and staff on how to deliver care in line with national standards and best practice guidance.

Staff had used nationally recognised assessment tools to identify risks such as malnutrition and skin breakdown. However, these assessments were not always accurate or updated when people's needs changed. Care records did not consistently provide staff with clear instructions on how to respond to identified risks.

The International Dysphagia Diet Standardisation Initiative (IDDSI) Framework is a global, standardised system of 8 levels (0-7) that describes food textures and drink thicknesses for people with dysphagia (swallowing difficulties). It aims to improve people’s nutritional safety by providing a common language for everyone to use. Staff were not using the IDDSI framework when describing people’s diets, thereby increasing nutritional risks due to the use of inconsistent language for textures and drinks. We found inconsistencies in recording between people’s care records, menus and information provided to kitchen staff. We could not be assured people were consistently receiving food and drinks prepared to the texture levels recommended by Speech and Language Therapy (SALT). This increased the risk to people of choking and poor nutritional outcomes.

Most people living in the home were routinely provided with drinks in spouted beakers. However, care records did not consistently explain why these were required. Lidded spouted cups can increase choking risks and are not generally recommended unless there is a specific assessed need. The absence of clear rationale demonstrated practice was not always guided by current best practice or individual assessment. The registered manager arranged for the SALT team to visit the home and provide staff training following our feedback.
 

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff described effective communication and delegation of tasks to ensure people’s needs were known and met. Staff told us they were allocated to work in different areas of the home, so they were clear as to their roles and responsibilities on each shift. One staff member told us, “We always do handover and we always inform each other if there is something going on with a resident.”

During our inspection we observed staff informing other members of their team when they were engaged with people or going on their personal breaks. This ensured other staff were aware when they needed to provide further oversight and support.

There were effective arrangements to share information with the local GP practice on a weekly basis. The GP reviewed this information and visited the service to assess people where concerns or needs had been identified.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People had access to appropriate healthcare support, and healthcare professionals. This helped to ensure people received timely interventions and ongoing support to manage their physical health conditions.

Staff promoted people's physical wellbeing through daily routines and activities. Most people were encouraged to spend part of their day in communal areas rather than remaining in their bedrooms. At lunch time people in the communal lounge were encouraged to move to the dining room to eat their meal. This ensured people who were able to mobilise independently relieved pressure from vulnerable areas and maintained their mobility. It also encouraged people to socialise.

Some activities specifically focussed on people’s physical wellbeing through the opportunity for gentle exercise. The staff member responsible for activities explained, “Most are in their wheelchair, so they don’t have that movement, so I always give them stretching because it is good for their blood circulation. We have materials we bought for stretching and things like passing the ball. It is very important to give them the physical activities."

The provider had further strengthened this approach by commissioning an external exercise therapist to visit the home on a fortnightly basis. This gave people additional opportunities to participate in structured physical activity and promoted ongoing engagement in exercise suited to their individual abilities and needs.
 

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

There were some systems in place to monitor people's health and wellbeing, and staff were able to identify and respond to changes in people's conditions. However, record keeping and oversight were not always effective in demonstrating people's needs were being consistently monitored or actions were taken to improve outcomes.

Records used to monitor people's healthcare needs did not always contain sufficient detail. For example, 1 person assessed as being at high risk of weight loss had regularly declined meals during the week prior to our assessment. Despite this, there was no evidence staff had offered additional encouragement, snacks or alternative meal options to support their nutritional intake. Food and fluid monitoring records lacked detail and did not always demonstrate appropriate action had been taken when concerns arose.

Daily care records completed by staff were not always reflective of people's assessed needs. They did not consistently evidence people had received oral care or personal care at the frequency identified within their care plans.

Repositioning records did not evidence people were being re-positioned as directed in their care plan. One person’s care plan recommended 4 hourly repositioning, but the records reviewed for the week prior to our assessment, indicated on 1 occasion, the person had remained in the same position for 11 hours, and on another occasion for 8 hours. Whilst this did not appear to have caused damage to the person’s skin, it further demonstrated a lack of oversight of monitoring records.

Despite these concerns, staff demonstrated a good awareness of changes in people's health and could describe how they monitored people for signs of deterioration. For example, staff explained how they monitored people with catheters for signs of infection or blockage and how concerns regarding skin integrity were promptly reported to nursing staff. One staff member told us, “When we give a wash we check for dryness or redness. If there is any redness, we are taking a picture and repositioning immediately. All staff are very careful about people’s bed sores and their needs.” Another staff member said, “We will inform the nurse if there are any concerns. When you say something, the nurse makes sure they check straightaway.”

Staff provided examples of supporting people to achieve positive outcomes. One person had progressed to having their catheter removed, while another had improved their mobility and was now able to walk with a mobility aid rather than relying solely on a wheelchair.

Although people experienced some positive outcomes, poor record-keeping and oversight meant the provider could not consistently evidence how outcomes were monitored, evaluated or improved.
 

The provider did not tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

People's rights to make their own decisions were not respected or protected. Significant shortfalls in the management of consent, mental capacity assessments and restrictive practices. This meant the provider could not demonstrate compliance with the Mental Capacity Act 2005. As a result, people were at risk of unlawful restrictions. There was insufficient evidence to show people had been supported to make their own choices wherever possible. Where decisions had been made on people's behalf, records did not always demonstrate these were made in their best interests.

Restrictive practices such as wheelchair seat belts and bed rails were being used without appropriate oversight, assessments, or documentation to demonstrate they were lawful, necessary, and proportionate. This meant people could not be assured restrictions on their freedom were being applied in line with relevant legislation and best practice.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Capacity assessments were often generic rather than decision-specific and did not clearly demonstrate how people had been supported to understand, weigh up and communicate decisions about their care and treatment. Most people had only 1 mental capacity assessment in place to cover a range of decisions. This meant the provider could not be assured people's capacity had been appropriately considered for each specific decision. There was a lack of evidence about how information had been shared with people to ensure they had the maximum opportunity to make their own decision.

Some mental capacity assessments had been completed by night staff in the early hours of the morning and did not evidence people’s involvement in the decision-making process.

We also found examples where consent for photography had been obtained from representatives despite the person having capacity to provide consent themselves. This indicated systems did not always promote or recognise people's right to make their own decisions where they were able to do so.

Feedback from people varied. One person said, “I’m not involved in my care, it’s just done,” whilst another person told us, “They always ask, and listen to what I want.”