Bromford Lane Care Centre

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

This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of 1 legal regulation in relation to gaining people’s consent.

This service scored 29 (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 make sure people’s care and treatment was effective because they did not assess, review and discuss people’s health, care, wellbeing and communication needs with them.

The provider failed to robustly review people's care plans to ensure these continued to reflect their current needs. For example, for 1 person who had distressed responses there was a lack of guidance for staff on how to recognise possible triggers. There was no clear guidance for staff on how to apply individual de-escalation techniques or reduce the people’s agitation and distressed behaviours. For example, we observed 1 person clearly unhappy about being transferred from their chair into a wheelchair and into the dining room, yet staff continued with this process. This resulted in the person becoming very angry and causing others in the dining room to become angry and upset. Staff did not engage effectively with the person and the whole mealtime experience, for everyone was adversely impacted.

For another person who was unable to communicate effectively in English, frustration due to communication barriers was a known trigger for distressed behaviours. However, effective communication methods were not implemented for this person. Their care plan referred to the use of flash cards to support with communication. However, during the days of our assessment, we found these were not used by staff to aid effective communication. People whose first language was not English did not have key information about their care available to them in their preferred language to allow them to be effectively involved in their support planning and review.

We also observed people were not given the option as to whether they had a call bell in their rooms. These had also been removed from communal areas without clear rationale or assessment of individual’s needs. This demonstrated an ‘institutionalised’ and not a person-centred approach when assessing the needs of people on the equipment needed for safety. One relative we spoke with about this told us they had concerns about not being able to call for assistance when in the bedroom with their loved one, especially as they had experienced other people coming into their loved one’s room.

Although many people and relatives were happy overall with communication with the service, multiple relatives told us they were not involved in reviewing support plans, and some had never seen a care plan.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

The provider failed to ensure people’s support plans included all their needs, including health, personal care, emotional support, social interests and activities, and cultural, religious, and spiritual needs. People's needs were not always assessed, and care and support were not always delivered in line with current standards. The provider’s processes for ensuring people were consistently involved in their care planning and that the information recorded in support plans was accurate, were not effective. Important information about people’s care and support needs had been omitted from some support plans. Some people’s support plans did not reflect national and best practice guidance in relation to support with specific health care needs, such as diabetes and strokes.

For people who required enhanced monitoring or support with repositioning in relation to their skin integrity and hourly safety checks, there was a lack of evidence this had been consistently provided. For people whose fluids were being monitored due to being at risk of dehydration, there was a lack of evidence to demonstrate their fluid targets were being met or monitored. Many people on fluid monitoring did not have fluid targets recorded so it was not possible to assess if they were receiving adequate fluids as per their assessed needs. The provider failed to carry out robust checks or monitor the completion of such records to ensure people's care and support achieved effective outcomes.

People and relatives told us they were not involved in reviews or assessments completed by the provider once starting to use the service.

Where people were assessed as requiring specialised diets, we found these needs were not suitably met. The kitchen team were using unapproved methods to thicken foods which were not in line with the provider’s policies and procedures. We found that although the kitchen team had received basic training for modified diets, they had not received specific training on how to prepare foods to the correct consistencies. The choice of meals, puddings and snacks on offer reflected people’s individual needs and known food preferences.

We observed drinks were accessible in the communal areas and people’s bedrooms; however, snacks including fresh fruit were not.

Where people were unable to verbalise their mealtime choice, pictorial menus had been introduced. However, during mealtimes we observed people were not consistently shown the options available using these pictorial menus to support their choice. This meant people unable to communicate their preferences verbally were not given the same options as those who were.

At mealtimes a choice of cold drinks were offered. However, we observed 2 people repeatedly asking for a cup of tea, but staff told them they had to wait until after lunch. Condiments were not offered and were not available on the first 2 days of the assessment. After we brought this to the provider’s attention this aspect of the mealtime experience had improved on our third visit.

The provider used a dependency tool to assess the level of staffing needed to meet the needs of the people using the service. The registered manager told us that if a person needed one-to-one support, they would increase staffing levels. The registered manager told us they had not carried out call bell response times checks. Due to a lack of any structured or robust approach to monitoring staff response to call bells, this meant they could not clearly demonstrate if these were managed in an acceptable timeframe and met the needs of people. Some relatives told us they felt that staff levels, particularly at the weekend and night, were low. One relative told us, “No, I don’t think there are enough staff. I visit at the weekends and there doesn’t seem to be enough. They need more staff.” Another relative told us, “Yes, they have enough staff, and I usually see the same staff. On [person’s] floor they have a lot of high dependency residents, and they always cover staff who are off sick. They bring in staff from the other floors.” Whilst we observed what appeared to be adequate staffing during the assessment, some staff told us that on the more complex units they felt staffing levels needed to be increased for the safety of both people who used the service and staff. The provider told us they had increased staff numbers in the previous 2 weeks.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

The lack of robust systems and documentation impacted how well information about people’s care was shared both internally between staff and externally with other services and health professionals. For example, agreed actions from the provider’s daily head of department meetings were not consistently communicated to the relevant staff or followed up. Where, following a change in needs, people required formal reassessment by the local Speech and Language Therapist (SaLT), this had not been acted on in a timely manner.

We were told by staff and records demonstrated that team meetings took place; however, they were not consistently used to drive improvements in people’s care. This meant there were missed opportunities where areas of concern or positive feedback could be discussed and actioned. However, staff told us they felt supported by the management team.

Feedback from health professionals we spoke with was mixed. Some felt that communication with the service and the standard of people’s care records still needed to be improved to ensure the support people received met their needs. However, others felt that the provider communicated and worked well with them to achieve the best outcomes for people.

There was lots of positive feedback from people and relatives about the service. Many relatives told us they had either spoken with or seen the management team. One relative told us, “The manager [name] is easy to speak to.” Another told us, “I don’t interact with them [manager] enormously. When I’ve needed help, they’ve made themselves available.” Feedback from people and relatives about whether they had been asked to complete feedback forms was mixed, but we did see evidence that their feedback had been sought, analysed and actioned.

The provider needs to improve how they support people to manage their health and wellbeing, so people can maximise their independence, choice and control.

The systems and processes to ensure care records and risk assessments were reflective of the support people required with their health needs were not consistently robust. This meant staff did not always have the correct guidance on how to support people appropriately to manage their health and wellbeing, whilst encouraging independence. We observed restrictions were in place for 1 person who was able to mobilise but was at high risk from falls. These restrictions had not been correctly assessed in line with the person’s rights under the Mental Capacity Act (MCA) 2005 and risk assessments were not in place. This placed the person at increased risk from falls due to them trying to get out of bed and avoid the pressure alarm. Alternative, less restrictive and safer systems to alert staff and keep people safe had not been explored. A relative told us that whilst their loved one was being supported with one-to-one care they had fallen and sustained and injury. They were told by the provider that the staff member had left the room due to an issue in the corridor. This resulted in the person sustaining an injury which, if the staff member had been present, may not have occurred.

Nursing staff could tell us how they would access additional support from healthcare professionals to help people manage their health, should this be required. However, records demonstrated that staff had not always escalated health related concerns. We found that the management of diabetes was not robust and staff had not monitored people who had unusually high blood sugar readings or contact other health professionals for advice. In addition, staff had not received in depth training to support people with their specific health conditions, such as drug and alcohol dependency and associated dementia, specific communication needs and diabetes management.

People’s weights were being monitored and we found overall that where people had lost weight, appropriate medical advice had been sought.

People told us they were able to make choices and decisions, but not all people were involved in reviewing or consulted about their health and well-being needs.

People and their relatives told us they felt medical referrals such as doctors, dentist and opticians were made where necessary, in a timely way, and were happy with this area of support.

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

When carrying out reviews of care plans the provider did not routinely include people or relatives. The staff responsible for updating support plans confirmed they did not invite the person or their relatives to contribute to the updating of information. The robustness of these reviews needed to be improved as we identified areas where required changes and updates to care plans had not been made.

We saw that some compliments and complaints about the service were recorded; however, these were not analysed to help drive improvement. Some relatives made us aware of complaints they had raised which had not been recorded or suitably addressed or actioned. The management team failed to record meetings which had been held in response to relatives raising concerns in relation to the standard of care provided. This meant the complaints records held were not an accurate reflection of concerns raised about the service.

Staff supervisions and appraisals had taken place, but the system used was not robust in ensuring all staff received meaningful supervisions. They did not consistently demonstrate that staff were provided with an opportunity to discuss any concerns they may have about people’s care or how it could be improved.

The provider failed to carry out robust investigations when incidents occurred taking lessons from these to drive improvements and ensure positive outcomes for people. We found that where lessons learnt had been recorded, there was no evidence to demonstrate these had been shared with the wider staff team or actions taken, where required.

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

The provider was not compliant with the Mental Capacity Act (MCA) 2005. The provider had not consistently obtained evidence that those making decisions on people’s behalf had the necessary legal authority to do so. This meant the provider could not assure themselves people were being supported in the least restrictive way and decisions were not being made on people’s behalf inappropriately. Where best interest decisions had been made on people’s behalf, these were not clearly recorded in people’s support plans. Applications for Deprivation of Liberty Safeguards (DoLS) authorisations were not effectively managed and where conditions had been applied to approved authorisations, these were not consistently monitored to ensure compliance with these. This meant that we could not be assured conditions applied to people’s DoLS authorisations were always being met. The provider did maintain records of people for whom they had made DoLS referrals and when they had been approved.

Some staff members we spoke with were unable to tell us which people had DoLS authorisations in place or how to find this information. This was of particular concern as, without staff knowing this information, it was unclear how they could ensure they were adhering to the specific conditions on these once approved. This placed people at risk of being unlawfully or inappropriately deprived of their liberty. We continued to observe doors to dining rooms and lounges being locked. This meant people were unable to freely access these communal areas and, in some cases, this meant they were also unable to access the garden freely. We identified this restrictive practice at the last assessment and the provider’s own audits identified the continuation of this practice. The management team had failed to ensure they minimised any restriction on people’s freedom of movement and access to important communal areas. .

We observed staff knocking doors prior to entering people’s bedrooms.

Most staff had received training in relation to consent, MCA and DoLS.