Bromson Hill Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met.

This service scored 57 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People did not always receive personalised care based on a comprehensive and accurate understanding of their needs. Risks were not consistently identified or appropriately assessed, and care plans did not always contain the information staff needed to provide safe, responsive, and person-centred care. Details about people's preferences, support needs and risks were sometimes missed, increasing the likelihood that care would not reflect their current needs or wishes.

People, or those acting on their behalf, were not routinely involved in reviewing their care. This meant opportunities to ensure care remained personalised and responsive were missed.

Care plans were often task-focused and contained limited information about people's likes, dislikes, personal routines and what was important to them. Many care interventions appeared to have been generated through the electronic care planning system rather than being developed from a detailed assessment of each person's individual circumstances. For example, 1 person who was unable to communicate verbally had a care plan that instructed staff to recognise non-verbal signs of distress. However, there was limited information about personalised distraction and diversion strategies to support the person’s emotional wellbeing. This meant staff may not always have had sufficient guidance to provide person-centred support.

Despite the lack of information, staff demonstrated a good understanding of the people they supported and how their life experiences and backgrounds influenced their emotions and behaviours. One staff member told us, “We are carers and we are here to really understand the residents. There is always a trigger for them to be acting that way.” They described how 1 person's reactions in certain situations could be linked to memories from their past, explaining, “That was the trigger, maybe a flash back from his memories. He is probably seeing other things that remind him of his past.”

Staff showed a commitment to developing their understanding of people's individual experiences. One staff member described the positive impact of recent dementia training, telling us, “Most of the residents have dementia, so the training gave me more input about how people are feeling and seeing things. It was a good experience so now I can understand them better than before.”

Most staff demonstrated a good understanding of people's individual needs and were often able to provide appropriate support based on their knowledge of the people they cared for. We observed staff using their knowledge of people's interests and preferences to engage them meaningfully. On several occasions, staff played music that was significant to individuals and captured their attention.

However, the provider was actively recruiting new clinical and care staff, and we found care delivery relied heavily on the knowledge and experience of long-standing staff rather than robust care planning and evidence-based systems. This increased the risk of inconsistencies in care delivery and person led care.
 

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Systems were not always effective in ensuring healthcare advice was fully integrated into care planning and ongoing monitoring. This created a risk important interventions, reviews and follow-up actions could be overlooked.

Recommendations from healthcare professionals had not always been incorporated into systems designed to ensure continuity of care. For example, 1 person's medication had been discontinued following professional review, with advice their blood sugar levels should be retested 3 months later. However, this had not been diarised or incorporated into any monitoring system, meaning there was a risk the required follow-up testing could be missed or forgotten.

Some guidance from healthcare professionals had not been fully embedded within care records. One person had received specialist advice to support their arm following a health event. Whilst the guidance was displayed in the person's bedroom, it had not been added into their care plan. As a result, it was unclear whether staff were consistently following the advice or whether the intervention remained appropriate and relevant to the person's current recovery needs.

Another person's dietary requirements based on information provided by the hospital was displayed in their bedroom. However, this information was not clear in records within the person’s care plan, the menu information available to staff, or the information used by kitchen staff. This created a risk of confusion and the potential risk the person may not receive food and drink in accordance with their assessed needs and professional recommendations.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Feedback from most people and relatives indicated they had not been involved in developing their care plans and had not seen copies of them. This meant information about their care and support was not always shared in a way that promoted full involvement.

Assessments to establish people’s preferred methods of communication required improvements. For example, 1 person's communication care plan did not fully consider sensory needs, such as whether glasses or hearing aids were needed to support effective communication.

Another person needed to wear glasses and hearing aids to communicate effectively. The use of these aids had not been recorded within an assessment undertaken to establish their capacity to make decisions. There was also no information about how the person had been supported to understand the information relevant to the decision, despite the assessment concluding they lacked capacity to do so. This meant there was insufficient evidence information had been presented in a way the person could access and understand before a decision about their capacity was made.

Information was available in a range of different formats. For example, menus and information about daily activities was displayed in both written and pictorial formats. People were also supported to choose their meals using photographs of menu options, promoting informed decision-making.
A regular newsletter was circulated to people and their relatives which included good news stories, birthdays, photographs, and information about upcoming activities, ensuring people were kept informed about life within the home.
 

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

People had limited opportunities to express their views, share experiences, or contribute to the development and improvement of the home. The registered manager told us there had been no recent, and were no planned meetings for people or their relatives. Furthermore, the providers system to gather feedback about the service provided through 6 monthly surveys did not include seeking feedback from people. As a result, the views and experiences of people using the service were not routinely sought or used to influence or develop practices.

Records showed people were not routinely involved in planning their care. Whilst there was some evidence relatives had been consulted about their family member's care needs, this was inconsistent and records did not reflect ongoing engagement or regular review discussions. This meant the provider could not demonstrate people and those important to them were actively involved in decisions about care and support.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Managers and staff understood how to support people to access external healthcare services. Staff monitored people for any changes in their health and acted promptly when concerns were identified. Close working relationships with the GP, frailty nurse and clinical pharmacist meant people received timely interventions when their needs changed. Referrals had been made to wheelchair services, dieticians, and speech and language therapists when required. This helped ensure people, including those with protected characteristics, could access the services and support that were important to them.

Staff accompanied people to health appointments and social engagements and organised transport when required. The registered manager told us they had autonomy to plan for this and provided additional staff to ensure people received appropriate support.
 

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

People did not always experience equitable care and support. People requiring a modified diet were not offered the same meal choices as others, and care plans did not always consider people's sensory or communication needs. People were not routinely involved in planning their care and their views were not actively sought or recorded.

The environment had not been adapted to meet the needs of people living with cognitive or sensory impairments. Environmental risks already detailed in the report meant people were not always safe or encouraged to move around the home independently.

Although the provider had invested in improving the garden, we were told people could not access the garden independently without staff support. This limited opportunities for people to make choices about how and where they spent their time.
 

People were supported with care at the end of their lives. Staff worked closely with external professionals to help support and care for people.

People received compassionate and respectful care at the end of their lives. Staff were seen to provide comfort, reassurance and support that reflected people’s needs and preferences. Staff appeared to know what was important to people, and we saw people’s musical and religious preferences were considered. However, records did not always reflect these wishes and needed further development to ensure continuity of care.

Thank you cards from relatives included positive comments about the care their loved ones received as their health deteriorated.

A healthcare professional spoke positively about the care at Bromson Hill. They told us staff were responsive when people approached the end of their lives. Staff worked effectively with health care professionals to ensure medicines were available to maintain people’s comfort at the end stage of life.