Bromson Hill Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service.

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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

Care practices were not always reflective of current standards and guidelines. For example, prescribed thickening agents were not safely and securely stored and risks in the environment had not been identified and addressed. People were being restricted without authorisation, care records were not always accurate, and pressure relieving equipment was not always set correctly.

Conversations with the registered manager demonstrated they were not always aware of some accepted practices in the home and a fundamental lack of effective audits and checks, meant there was lack of direction to drive up standards and expectations.

The registered manager described recent challenges due to issues around the provider’s overseas sponsorship licence for employees. This meant key members of clinical staff had recently left the service and a new clinical team was in the process of settling in.

Staff told us they enjoyed working at Bromson Hill and valued the ‘family’ atmosphere within the home. Comments included, “It is the best experience I have had because we are family here. We are treating all the residents like our grandparents,” and "More like family, colleagues are very supportive, my boss is so nice. It is very nice."

Not all leaders understood the context in which the provider delivered care, treatment and support. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

The registered manager and provider did not demonstrate sufficient knowledge or oversight of relevant legislation and best practice. For example, they were not aware of, or compliant with, requirements relating to window restrictors, the safe storage of thickening agents, safeguarding responsibilities, statutory notifications, and the application of the Mental Capacity Act.

The registered manager told us they were unaware of some restrictive practices being used, staff not consistently following infection prevention and control guidance, or how clinical staff were administering covert medicines. This indicated they did not have sufficient oversight of care practices within the service.

Despite these shortfalls, staff, people and relatives spoke positively about the registered manager and described them as approachable, supportive and caring. One person told us, “[Registered Manager] seems good. It seems well run here,” and another said, “I think she is very open and easy to approach.” Staff agreed and comments included, “She treats everyone here as family. She is very open, she listens to everyone's concerns and suggestions,” and “She is very supportive of us all.” Staff also described the registered manager as actively involved in the life of the home and spending time with people who lived there.

While the registered manager was visible, compassionate and valued by staff and people, this had not translated into effective oversight, regulatory compliance or continuous improvement.
 

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff felt able to speak up and told us the registered manager was visible and available to them if they needed to voice any concerns. One staff member told us, “[Registered manager] is very open, she listens to everyone's concerns and suggestions and there is a meeting and we will talk about this and that.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

A diverse staff team has been recruited to support people living at Bromson Hill. Staff told us diversity within the workforce was valued and they had not experienced or witnessed any discrimination. One staff member commented, “There is no discrimination, only inclusion. Everyone is treated so well." Another staff member told us, “We are team here, we have very nice teamwork."

Staff told us how their diversity had been recently celebrated at a summer fun day, where they were encouraged to cook and share food from their own cultures, with people, each other and with families.

The registered manager encouraged staff to develop their skills and knowledge and supported professional development through accredited qualifications and additional training opportunities. They registered manager told us, “I try to empower staff. Some care assistants have completed complex training that is usually intended for nurses because I want them to continue developing their skills.”
 

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider did not have effective governance arrangements in place to ensure the quality, safety and compliance of the service. Systems to monitor and improve the service were not operating effectively, resulting in significant concerns remaining unidentified and unaddressed.

The providers systems and processes to monitor and improve the quality and safety of the service were not effective. Provider and service-level audits had failed to identify a range of issues we found. These included environmental safely risks, failure to follow regulatory requirements in relation to the mental capacity act, and safeguarding expectations.

Management oversight of audits and quality checks delegated to staff was ineffective. This meant audits had not been completed accurately to reflect the quality of the service and areas for improvement. As a result, known risks had not been adequately mitigated and systems intended to keep people safe were not consistently followed.

In addition, the service's CQC rating was not displayed in the home, and providers have a legal obligation to do so. Staff told us it had been removed during redecoration several months earlier, but no audit or monitoring process had identified this omission and the registered manager was unaware it had not been replaced. Following our feedback, the registered manager gave us assurances this would be addressed.

These findings demonstrated widespread and significant failures in governance, oversight and quality assurance, which resulted in breaches of regulation and placed people at risk of receiving unsafe and inconsistent care.
 

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Staff worked well with external health care services. People received regular input from a range of health services, including weekly visits and reviews from GPs, a frailty nurse and a clinical pharmacist. A healthcare professional spoke positively about the approach to partnership working. They told us, “They welcome any support and guidance. They are extremely responsive and receptive. If I send any information regarding conditions, they print it and cascade it.”

Staff maintained links with the wider community. Families and friends were welcomed into the home. We observed positive interactions and communication between staff and visitors. This included mealtimes, where relatives were welcomed to eat with their family member.

The registered manager had started to develop connection with the wider community, including inviting children's groups into the home during special events and welcoming representatives from different religious groups to visit and engage with people living at the service.
 

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

The provider had not demonstrated effective learning from previous assessments or used findings to drive sustained improvement. This was the 5th consecutive CQC assessment where the provider had been unable to evidence, they were delivering care that met the standards expected of a good service.

Whilst there had been some positive changes to the culture of the home, a number of concerns identified during this assessment reflected issues on which we had previously reported. The provider had not developed effective systems or processes to strengthen governance, oversight, or quality assurance. This meant risks and poor practice continued to go unidentified and opportunities to improve people's experiences and outcomes were missed.

There was limited evidence learning from incidents, audits, complaints, or feedback had been used to implement and embed lasting improvements.