Bromford Lane Care Centre

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we did not rate this key question. At this assessment the rating is inadequate.

This meant people were not treated with compassion, their dignity was not consistently protected and staff did not consistently demonstrate a caring attitude.

The service was in breach of 1 legal regulation in relation to a failure to always ensure the dignity and respect of people using the service.

This service scored 30 (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 treat people with kindness, empathy and compassion, or respect their privacy and dignity.

Systems to assess, monitor and mitigate risks to people, including risks associated with the care environment and support planning were not always robust and did not always demonstrate a caring approach. Audits and checks completed by delegated staff had not enabled the provider to identify and address the significant concerns we found during this assessment. These included shortfalls in the assessment and management of risks to people and the safety of the environment. Staff had not always been provided with clear guidance on how to safely meet people's individual needs. Staff did not always report incidents or safeguarding concerns in a consistent or timely manner, which meant people were not always cared for in a safe way.

We saw lots of positive interactions between staff and people they were supporting during the assessment, and most staff had received training in relation to dignity and respect.

Whilst people and relatives told us they felt staff were caring towards them, our findings did not always indicate people were consistently supported safely. Most people told us they felt staff were kind and compassionate and treated them with dignity. One relative told us, “The good thing about the home is the caring and kind staff. The entertainment staff try very hard and are very good. The décor is a bit basic; it feels a bit like a combination of a school and a hospital with long corridors and lots of rooms off them.” However, 2 relatives told us about the poor experiences they had with the lack of basic care needs being met. One relative told us, “I have witnessed poor standard of care on numerous occasions such as staff feeding [Name] in lying down position, putting fluids and food on bedside and not supporting her, she is unable to reach and get this herself, staff going in an walking straight past her to scan the barcode with no acknowledgement.”

We observed people’s dignity was not always respected due to the actions of staff and the provider. Shower curtains had been systematically removed throughout the service including in communal bathrooms. This was of particular concern as when opening the doors in communal bathrooms, people in the corridor had full view of the bath. This had the potential to impact on a person’s dignity.

The provider did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The provider did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

At the last assessment we discussed the care environment with the registered manager as this had not been adapted for people living with dementia. At this assessment, although some bedrooms had been redecorated and work had commenced on repainting the corridors, the needs of people using the service had still not been fully considered. This included a failure to consider best practice guidance on the use of signage, lighting, individualised doors and decoration to create a dementia-friendly environment. The garden area also required improvements to make it safe for people to use independently and lacked areas of interest, stimulation and suitable seating for people to enjoy the outside space. Most people we spoke with told us they were happy with their rooms, and many had pictures and personal items to make their rooms feel more homely. However, the decoration of these rooms required improvement to reflect best practice for dementia care. Although communal areas were large and had lots of potential for development, they were unappealing with little to stimulate people using these spaces. Chairs were set out around the edge of the room with some chairs being positioned so anyone sitting in them would be unable to watch the TV, if they wished to.

However, some relatives told us of their concerns in relation to the lack of activities and stimulation for people, particularly those cared for in bed or who chose to stay in their rooms. This meant, at times, people were not engaged in meaningful activities for long periods of time and were at increased risk of isolation in their rooms. A relative told us, “A lot of the people I see here are bed or seat bound and just sleeping in the communal areas and there’s not a lot of activities for them.” The lack of activities and meaningful engagement were also demonstrated in people’s daily care notes. Staff also failed to recognise the importance of positive interactions and meaningful activities. This was demonstrated by our observations of staff allocated to provide one-to-one support. We saw these staff only interacted with the people they were supporting to a limited extent and did not, for example, offer to support them to access the home’s garden. One relative told us, “They [staff] don’t seem that skilled. I feel that the one-to-one carer is inexperienced, just caretaking not engaging with her. I’d like to see an hourly breakdown of how [name] is behaving and what they are doing to support them, but I haven’t been given this.” One health professional we spoke with was very positive about the activities and one-to-one support provided.

There were a team of activity co-ordinators working in the service who had developed an activity plan based on what they identified people enjoyed. During the assessment we were told that the provider was in the process of recruiting a new activity team member to increase the activity hours.

The provider did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and wellbeing.

At this assessment we continued to observe, during 2 separate mealtimes, staff not offering choice at mealtimes for those who found it difficult to verbalise their choice of meal option. We also continued to see staff putting on people’s clothing protectors without asking them beforehand. This did not promote people’s choice and control. We did observe staff supporting some people with their meals, although overall the engagement from staff to provide verbal prompts and encouragement at mealtimes was lacking. We observed 1 person who was brought into the dining room and was positioned facing a wall, without being given an option of where to sit. This person was sat for 40 minutes before they received their meal and there was minimal engagement with them from staff.

We continued to see, in some aspects of the service, evidence of a blanket approach to decision-making. For example, people could not access a dining room which led onto the garden, a communal lounge or the reminiscence room. We also continued to find many people’s individual choices and abilities were not considered prior to making the decisions, such as removing call bells and the use of bed rails. These decisions were made without consultation with people or clear rationale.

Whilst many people were happy with the activities provided, some relatives told us they felt their loved ones would benefit from more meaningful activities to keep them occupied. We were told about, and saw during our visit evidence of, some group activities taking place. At times, competing activities or noise levels in 1 lounge may have been overwhelming for people as the TV was on with no volume on, music was playing, 1 staff member was doing ball games whilst another was doing arts and crafts. One person told us, “Sometimes the staff and residents throw small balls to each other. Sometimes I like to have a walk in the garden. I think they could have more activities in the home.” Another person told us, “I do get involved in activities such as board games, skittles and volleyball outside in the garden sometimes.” However, some relatives were very positive about the activities and stimulation. One relative said, “There’s a great activities team there and they get [person] out of her room dancing and singing. They have karaoke nights.” We observed a selection of group activities taking place during our visits to the service with many people engaging and appearing to enjoy these such as singing and arts and crafts. However, trips out to local places of interest or attractions were limited. This was confirmed by people using the service and staff. The management team told us they hoped to increase trips out as they were increasing the activity team hours. During the 5 days of the assessment, we did not observe any therapeutic activities being offered. However, on the last day we were shown the previously locked reminiscence room which had been changed into a sensory room for those people living upstairs.

For people who smoked we observed from records they were able to do so during the day and nighttime hours, if they chose to.

Most people and relatives we spoke with told us they felt they were encouraged to maintain independence and were given choices. People told us there were no restrictions on what time they went to bed or got up or where they wished to spend their day.

Staff had received training on promoting independence and they could explain how they supported and encouraged people to maintain independence.

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Some people told us when they called for or needed support they may have to wait longer than they would have liked. One relative told us, “I did raise a concern when [person] first moved into the home. Sometimes he would try and take care of his personal care as he did get frustrated when he had to wait for staff to support him.” Other people told us they felt they were provided with help when they needed it. The management team told us staff carried out various checks for people cared for in the rooms, at intervals ranging from 15 minutes to one hour, and for all people during the night. The new management team told us there was no clear rationale as to why such frequent checks were taking place and they would be reviewing these monitoring arrangements. These checks were recorded in people’s care plans. We observed alarm mats were in use to alert staff if people got out of bed or up from their chairs; however, these devices were not transferred with the person from their room to the communal area. Again, the new management team told us this was something they would be reviewing. We observed alarms linked to people’s movement sensors were positioned in corridors and on 1 occasion we observed 4 such alarms in an unoccupied lounge. One of these alarms had been activated but there were no staff in this area to respond, placing the relevant person at increased risk of harm. Care plans, risk assessments, mental capacity assessments and best interest decision forms for those who lacked capacity contained incomplete or conflicting information. This meant it could be difficult for staff to understand what was required in relation to ensuring people were safe when in their rooms.

We also found that on at least 4 occasions where people’s blood sugar readings were excessively high, medical advice had not been sought and no referrals to the diabetic nurses had been made.

We saw that, overall, staff were caring and responsive to people’s immediate needs but at times support could be task-orientated rather than a person-centred approach. For example, staff could not communicate effectively with 1 person due to language barriers which meant they could not recognise immediately if the person was in pain, discomfort, concerned or wanted something. The provider had failed to consider how they could remove these barriers and promote effective communication meeting the person’s individual needs. We also observed staff failed to identify another person’s distress and escalate this to the nurse on duty. This resulted in unnecessary prolonged distress for the person.

We saw evidence that when people needed emergency treatment, such as from the ambulance service, due to illness or injury, this was sought in a timely way.

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Some staff told us they felt listened to and valued by the management team and they felt they could raise any concerns they had. However, some staff spoke of how they were worried about speaking up as they would be ‘shouted at’. This did not reflect a positive and open culture in the service and increased the risk of concerns escalating due to staff not feeling confident to speak out when errors or incidents occurred.

Staff meetings took place periodically. However, the records of these meetings did not demonstrate how they were used to enable staff to feel valued and included in the improvement and development of the service. During our assessment the new management team changed the structure of the daily meetings which took place with the heads of department to make these more structured and ensure outstanding actions were followed up. Supervisions also took place; however, again, these did not demonstrate effective support for staff, particularly new staff who were in their probationary period.

The provider promoted staff recognition through an employee of the month programme to celebrate staff performance, achievements and good practice, and to enhance overall staff well-being.

The registered manager told us they had sought feedback from staff members which was positive overall. They had not analysed the most recent information, generated any actions or shared the findings with the staff members.