All inspections: Bromford Lane Care Centre

Date of assessment 23 July 2024 to 05 August 2024. Bromford Lane Care Centre is a care home, providing personal care for up to 116 people, in a purpose built building. At the time of our assessment the service was supporting 112 people. The service supports people with dementia, mental health, older people, physical disability and younger adults. At the time of the assessment, they were not supporting anyone with learning disabilities or autistic spectrum disorder. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities. The service provides 62 Emergency Assessment Beds for discharge from hospital before moving to the most suitable place of care. Most people using this pathway had very complex needs. The assessment was prompted by a review of information we held about the service. We found some people were not always treated with dignity and respect. This was a breach of regulation 10 (Dignity and respect) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Peoples consent was not always gained as per the principles of the Mental Capacity Act 2005. This was a breach of regulation 11 (Consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a failure to ensure staff had sufficient guidance and knowledge to support some people safely. This was a breach of regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found systems in place to monitor the quality of the care provided had failed to identify many of the issues highlighted during the inspection. Systems to ensure care was provided safely and appropriately were not always robust. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act (Regulated Activities) Regulations 2014.

At our last inspection on the 08 and 09 August 2017, we found the service required improvement under the key questions, is the service responsive and well-led with an overall rating of requires improvement for the service. At this inspection we found there had been sufficient improvement to now rate this service as good.

The unannounced inspection took place on the 12 December 2018 with a second announced visit on the 13 December 2018. Bromford Lane Care Centre provides accommodation over three floors comprising five separate units offering support for up to 116 adults with nursing care needs. Two units catering for the needs of people living with dementia, nursing care. Units A and G catering for the requirements of people living with complex needs including alcohol/drug dependency and/or other mental health conditions. The home also provides short stay interim beds (EAB unit) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or another form of care placement. At the time of our inspection there were 114 people living at the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People were kept safe. Staff understood how to protect people from risk of harm. People's risks were assessed, monitored and managed to ensure they remained safe. Processes were in place to keep people safe in the event of an emergency such as a fire. People were protected by safe recruitment procedures to ensure suitable staff were recruited. People received their prescribed medicines when required by trained staff. Staff understood their responsibilities in relation to hygiene and infection control.

People told us they received support from staff they felt had the skills required to support them safely. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People were encouraged to eat healthily. People had access to healthcare professionals when needed in order to maintain their health and wellbeing.

Staff encouraged people's independence where practicably possible. People received a service that was caring and respected their privacy. People were supported by staff who knew them well.

People received a service that was responsive to their individual needs. Care plans were personalised and contained details about people's preferences and their routines. People were supported to pursue hobbies and activities that interested them and processes were in place to respond to any issues or complaints. Where people’s faith was important to them, they were supported to continue with following their beliefs. This included their end of life (EOL) wishes.

The registered manager understood their role and responsibilities and staff felt supported and listened to. People and staff were encouraged to give feedback and their views were acted on to enhance the quality of the service provided to people. People and staff were complimentary about the leadership and management of the. The provider worked in conjunction with other agencies to provide people with effective care.

Quality assurance systems were in place to identify where improvements could be made and when needed implement these changes. The provider notified us of significant events that occurred within the home. Feedback was sought from people and their relatives and this was used to improve the service for people.

This was an unannounced inspection visit which took place on 08 and 09 August 2017. We last inspected this service on 29 May and 01 June 2015 where the service was meeting all of the regulations and rated as ‘Good’.

Bromford Lane Care Centre currently provides nursing care and support for a maximum of 116 people. Accommodation is provided over three floors comprising five separate units. Two units catering for the needs of people living with dementia, nursing care. Units A and G catering for the requirements of people living with complex needs including alcohol/drug dependency and/or other mental health conditions. The home also provides short stay interim beds (EAB unit) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or another form of care placement. At the time of our inspection there were111 people living at the home.

It is a legal requirement that the home has a registered manager in post. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We saw that the management of the service was stable and that the provider had established management systems to assess and monitor the quality of the service provided. However, they were not always effective at identifying the issues we found at this inspection. For example, dependency tools used to assess staffing levels had not recognised the need to increase staff numbers on the nursing unit for the first day of our inspection visit. Medicine audits had not identified gaps in recording topical creams and protocols for some ‘when required’ medicines were not in place.

There was a dedicated activities team that provided opportunities to optimise people’s social and stimulation requirements. However, there was mixed opinions on the effectiveness of those activities and whether people were being supported to maintain their individual hobbies and interests. People and most of their relatives were confident that if they had any concerns or complaints they would be listened to and matters addressed quickly. Although, some concerns discussed with us by relatives had not been recorded in the provider’s complaint’s process and this required some improvement.

The management team had a number of systems to gain feedback from people living at the home, relatives and visitors. This included resident/relative meetings, satisfaction questionnaires and regular reviews. People, most of their relatives, staff and visiting professionals told us the home was well organised and well-led.

People who lived at the home were kept safe. Staff were trained to identify signs of abuse and supported by the provider’s processes to keep people safe. Potential risks to people had been identified and appropriate measures had been put in place to reduce the risk of harm. People were supported by suitably trained staff that had been recruited safely. People received their medicines as prescribed.

Staff were trained and had the skills to meet people’s needs. Staff received supervision and appraisals, providing them with appropriate support to carry out their roles. Staff treated people as individuals, offering them choices whenever they engaged with people. Staff sought people's consent for care and treatment and ensured people were supported to make as many decisions as possible, where possible. Where people lacked the mental capacity to make informed decisions about their care, relatives, friends and relevant professionals were involved in best interest's decision making processes. Therefore, the provider had acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Food standards were to a good level. When we discussed the quality of meals with people and their relatives, they said the food was ‘good’. The kitchen staff ensured there were effective processes in place to support people with their nutritional needs. People spoke positively about the choice of food available. Staff supported people to eat and drink to maintain their health and wellbeing in a caring way. People were supported to access health care professionals to ensure that their health care needs were continuously met.

People were supported by staff that were kind, caring and friendly and who treated people with respect. Staff supported people in a dignified way. People were supported by staff and a management team that encouraged them to maintain relationships that were important to them. People’s health care needs were assessed and reviewed. Relatives told us the management team were good at keeping them informed about their family member’s care.

The inspection took place on 29 May 2015 and 1 June 2015 and was unannounced.

We last carried out a comprehensive inspection of this service on 15 April 2014. At that inspection we found the provider required improvements in the management of medicines. At this inspection we saw that improvements had been made in respect of the management of medicines.

On 12 November 2014 we carried out a responsive inspection because we had received some concerns about staffing levels at night. At that inspection we saw that there were sufficient staff to meet people’s needs.

Bromford Lane Care Centre provides accommodation and support for up to 116 people who require support with their personal or nursing care. The accommodation was split up into five units. Two units supported people with complex needs, one supported people living with dementia and another that supported people with nursing needs. The fifth unit supported people who had moved from hospital into the home for a short stay before they moved onto other permanent accommodation or were able to return home. At the time of our inspection there were 99 people living in the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were protected from the risks of abuse because the provider had systems in place to minimise the risk of abuse and staff were trained to identify the possibility of abuse occurring. Staff understood their responsibility to take action to protect people from the risk of abuse and how to escalate any concerns they had.

People were protected from risks of injury associated with their needs because risks had been identified and management plans put in place so staff had the information they needed to minimise risks. Staff knew how to protect people in emergency situations such as illness, injury or fire.

Staff had a good understanding of how to ensure that consent was obtained and how people’s rights were to be protected if they did not have the ability to make decisions for themselves.

People were provided with sufficient food and drinks throughout the day that met their needs. Support and advice was sought where people were not eating or drinking enough to remain healthy. People were supported to see health care professionals to ensure they received medicines and medical treatment as required.

Staff were caring and had an understanding of the needs of the people they were supporting. Staff received the training and supervision they needed to carry out their roles. At the time of our inspection there were sufficient staff available to meet people’s needs but some people and relatives told us they sometimes had to wait for assistance.

People were supported to maintain contact with their friends and relatives. Group and individual activities were available for people to take part in if they wanted.

Systems were in place to gather the views of people so that improvements could be made based on their wishes. Regular auditing and monitoring of the service ensured that the quality of the service continued to improve.

We carried out an unannounced comprehensive inspection of this service on 15 April 2014. After that inspection we received information about concerns in relation to the service. As a result we undertook a focused inspection on 12 November 2014 to look into those concerns. You can read a summary of our findings from both inspections below.

Comprehensive inspection 15 April 2014

Bromford Lane Care Centre provides residential and nursing care for up to 116 people. At the time of our inspection 109 people used the service and the home consisted of six units which included; a residential unit, a complex needs unit, a nursing unit, a dementia unit, an enhanced assessment unit and a unit for younger people with physical or cognitive disabilities. There was a registered manager in post at the home. This meant that there was an allocated person who was responsible for the day to day running and management of the service.

People told us they felt safe. We saw that staff understood the risks posed to people’s health and wellbeing and they knew how to keep people safe. We found that this process could be improved if there was a system in place to ensure documentation relating to risk was kept up to date.

The staff understood the needs of the people who used the service. Care records contained the information staff needed to provide care that was based upon each person’s personal preferences. However, systems could be improved to ensure that the information contained in people’s care records was up to date.

Care was provided with kindness and compassion by staff who were appropriately trained, but we found that staff would benefit from further training to develop their skills in dementia care.

Some people who used the service did not have the ability to make important decisions about some parts of their care and support. Senior staff had an understanding of the systems in place to protect people who could not make decisions about their care, support and safety. These systems followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This legislation sets requirements to ensure that where appropriate decisions are made in people’s best interests. However, we saw that other staff at the home were not always aware of their role in offering and supporting people to make choices about their day to day care and support.

The home promoted an inclusive culture. People told us their independence was promoted and we saw that staff provided care to meet people’s diverse cultural and religious needs.

People could not always be assured that they had received their medicines as instructed by the prescriber and effective systems were not in place to ensure medicines were stored in accordance with manufacturer’s guidance. We identified that improvements were required to ensure these systems protected people from the risks associated with their medicines. You can see what action we told the provider to take at the back of this report.

The registered manager had a noticeable presence within the home and the staff all reported that improvements to the quality of care provided had been made since the new manager had been appointed. The registered manager assessed and monitored the quality of the care so that improvements could be made.

The registered manager demonstrated they were committed to improving the quality of care and during our inspection we saw examples of good care that was based upon best practice evidence.

Focussed inspection 12 November 2014

Following our inspection of 15 April 2014 we undertook a focused inspection to look into concerns about the service. The inspection took place on 12 November 2014, and looked into concerns about staffing levels at night. During the visit, we spoke with a nurse and two care staff. People living in the home were asleep at the time of our visit.

We saw that there were sufficient numbers of staff on duty and appropriately deployed at night to meet the needs of the people on the two units we inspected. Staff spoken with told us there were sufficient numbers of staff to meet the needs of people. This showed that there were sufficient staff available to meet the needs of the people living there.

Staff spoken with were knowledgeable about the needs of people and how to manage identified risks. Staff were able to explain the actions they would take in the event of a fall and records showed that falls and actions taken in response were recorded so that they could be monitored and care records updated as necessary. We saw that people at risk of not eating and drinking sufficient amounts to remain healthy were identified and plans put in place to manage this. Where risks were identified referrals were made to the appropriate healthcare professionals to ensure that they were supported to eat and drink safely . This showed that people were supported to receive adequate amounts of food and drink to promote good health.