Bromson Hill Care Home

We reviewed all 5 key questions under our single assessment framework. The last assessment of the service was in November 2022 when the service was rated as requires improvement. At this assessment we identified 4 breaches of the regulations in relation to the safety of the environment, safe care and treatment, safeguarding, and good governance. We have asked the provider for an action plan in response to the concerns found relating to safety of the environment and safe care and treatment at this assessment. In instances where the Care Quality Commission (CQC) have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been concluded.

We identified risks relating to safety, governance and oversight of the service. Systems intended to assess, monitor and improve the quality and safety of the service were ineffective and had failed to identify a number of issues found during the assessment. These included environmental hazards, incorrect mattress settings, weaknesses in safeguarding practice, poor application of the Mental Capacity Act, and failures to comply with regulatory requirements. The provider's governance arrangements had not recognised or addressed these concerns, placing people at risk of avoidable harm.

Care records were not always accurate or reflective of people's current needs. Care plans did not consistently identify known risks or provide clear guidance on how these should be managed. This meant staff did not always have access to the information needed to provide safe and person-centred care. Although staff knew people well, recent staffing changes linked to the provider's overseas sponsorship licence meant experienced clinical staff had left the service and a newly established clinical team was still becoming familiar with people's needs. This increased the risk of inconsistencies in care delivery.

Mental capacity assessments were not always decision-specific and did not demonstrate how people or their representatives had been involved. In addition, some incidents that met the threshold for statutory notification had not been reported to us, CQC, as required, and some safeguarding concerns had not been appropriately investigated or managed in line with local authority safeguarding procedures. This increased the risk safeguarding concerns could go unrecognised and unaddressed.

We also found some people were subject to restrictions on their freedom and independence which had not been formally assessed, documented or reviewed to ensure they were necessary and proportionate.
The provider's auditing and monitoring systems had not identified the above concerns. Quality assurance processes were not sufficiently robust to provide assurance risks were effectively managed, that staff consistently followed best practice, or policies and care documentation reflected current guidance and legal requirements.

Staffing levels were sufficient, however staff had not always been recruited safely or received adequate induction or supervision to support the delivery of safe and effective care.

Despite these concerns, there was evidence of a positive and caring culture within the home. Staff spoke positively about teamwork and communication and consistently described the registered manager as approachable and supportive. People were supported by staff who treated them with kindness and compassion, and there had been improvements in the provision of activities, giving people greater opportunities for engagement, stimulation and social interaction.