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

Systems to assess, monitor and mitigate risks to people, including risks associated with the environment and support planning were not always robust and did not always demonstrate a caring approach. The provider’s governance and quality assurance systems were not sufficiently effective to ensure the delivery of good quality care and support. Audits and checks completed had not enabled them to identify and address a number of significant concerns we found during this assessment. These included shortfalls in the assessment and management of risks to people. Staff had not always been provided with clear guidance on how to respectfully meet people's individual needs or maintain dignity. 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. The provider failed to ensure people were supported in the least restrictive way to meet their individual needs and wishes. They also failed to ensure that support plans did not contain derogatory or labelling terminology and that staff did not describe people using such terminology. This was a breach of Regulation 10 (Dignity and respect) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst people and relatives told us they felt staff were caring towards them our observations did not always indicate people were consistently treated with dignity. One relative told us, “Some of the staff are really caring; some just get on with the job. Ideally, I would like them to spend a bit more time talking with them; being a bit more tactile rather than rushing.” Whilst another relative told us’ “The care generally is not very good.” One person told us, “I can have a laugh with the staff, and they get me anything I need.” Another person we spoke with told us, “They [staff] are very attentive to privacy and maintaining dignity. During personal care they always close the curtains.”

Staff told us about peoples support needs and how they worked with people to ensure they felt safe and cared for. However, some of the terminology used to 'describe' or 'label' people did not demonstrate compassion. One staff member told us how they liked working with ‘the naughty ones’. Other staff referred to people they supported as ‘aggressive’ or ‘wanderers’. Another staff member told us about cleaning people’s bedrooms and if the person was asleep in bed, they would continue to clean the room. This did not promote a person centred and respectful approach. Some staff and relatives told us about how staff changes caused disruption to people having familiar staff who knew people’s complex needs. The registered manager and provider told us they are committed to ensuring all people living at Bromford Lane Care Centre are cared for in a safe, caring way by all staff and have taken lessons learnt from our feedback.

Health professionals we spoke with felt staff were caring and sought advice and guidance in a timely way.

Overall, we observed positive, kind and caring interactions by staff towards people using the service, responding to people's needs in calm and respectful way. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. During a period of observed practice staff were patient when people carried out repeat requests or actions. This helped to alleviate any anxiety the person may have been experiencing. Most staff were interacting, but others did not engage with people at all, leading to a negative experience. On occasions staff were observed entering rooms without knocking or waiting to be invited in. We observed personal information was accessible in the foyer and reception area and medicine charts were left in a lounge. This did not protect people's privacy. Inappropriate language/terminology was seen to be used in people’s care plans to describe them and their support needs. We observed some staff failing to promote choice and independence during mealtimes. Some staff put protective aprons on people without gaining consent and care plans did not reflect this was their choice. We observed 1 staff member pulling a service user back by their arm and telling them to sit down at lunch time. We saw and were told that there were some barriers to effective communication with staff due to language barriers. Several staff were observed smoking in vicinity of windows to people’s rooms or communal areas. This did not take into consideration people's health conditions or choices not to be exposed to second hand smoke. Many people were observed wearing non-slip socks. There was no evidence this has been discussed or was in the persons best interests to make this decision. Whilst we acknowledge this action was taken to managing slips, trips and falls, the correct process was not followed on an individual basis and support plans did not reflect such practices.

We observed that communal areas of the home were very clinical in appearance. Although some areas had additional points of interest, others were bland in appearance. Some relatives also told us that they did not feel the environment felt homely. Some people we spoke with told us they were happy with their rooms and had pictures and personal items about. However, others felt more could be done to make the rooms more comfortable and inviting.

Managers told us they promoted a person centred approach, but this was not always evidence by the actions taken such as, blanket approaches to safety and risk taking. The registered manager told us they had engaged with a dementia specialist who they wanted to work with to improve the environment for people. However, this was in the very early stages, and this work had not been commenced.

Areas of the home where people lived with dementia were not particularly dementia friendly. There was no signage to guide people to lounges, dining rooms etc and there was limited tactile objects for people to easily access. The EAB unit where people using the service where only short term, would also benefit from signage to help direct people in unfamiliar environments. To divert people from doors to exit the unit where they lived, in the EAB unit the door had been covered with a brick effect paper, this could cause a level of anxiety for people seeing staff appear through a brick wall.

Based on our findings in relation to the ‘blanket’ approach to apply for DoLS authorisations, without considering peoples capacity, is not in line with MCA principles. There were no MCA or best interest decisions in relation to the blanket approach to remove all call bells and shower curtains. The providers own audits failed to identify these and the ‘restrictive practice’ where people did not have free access to the dining room, garden or activity room. Health professionals told us they felt the management and staff did their best to treat people as individuals, in what at times could be difficult and challenging circumstances.

Most people and relatives we spoke with told us they felt they were encouraged to maintain independence and were given choice. One relative told us how their loved one had been cared for in bed when they moved in but now, they were walking with a frame. Some relatives told us how they felt their loved ones would benefit from more meaningful activities to keep them occupied. We were told and saw evidence of activities taking place which included 1to1 in people’s own rooms, if they were unable to or chose not to participate in group activities. People we spoke with told us there were no restrictions on what they wanted to do.

Staff told us they had received training on promoting independence and how they supported and encouraged people to maintain this. However, they did not always put this into practice.

We observed on occasions, staff not offering choice at mealtimes and putting on clothing protectors without asking. Care plans did not reflect this was their choice or that it was in their best interest. This did not promote people choice and control. We observed 1 staff member preventing a person from going outside and pulling them back to the dining table by their arm without any meaningful conversation to understand why they wished to go outside. We also saw areas in the home which were locked and prevented people from moving freely into areas such as the dining room, garden or activity room. This meant people were unable to gain free access to the garden which had the potential to impact on people’s independence, choice and control.

There were daily walkabouts by the senior team members and staff were observed during these times to monitor the promotion of independence, choice and control. The providers own audits had failed to recognise that restrictive practices were in place.

Most people we spoke with told us if they need help, someone was there to help them. One person said, 'If I need them [staff], I just go to the door to ask for help." We observed and were told by the management that no one had a call bell. To ensure people were supported when needed the registered manager had allocated a staff member to carry out 15 minute observations of people in their rooms. Those at risk of falling from bed had alarm mats on their beds linked to a wireless system which staff monitored.

The registered manager told us call bells were removed due to risks to people and they had implemented the 15 minute checks to ensure people were not left without support when they needed it. The registered manager told us how they contacted other health professionals should people need additional support. Staff told us they had enough staff to support people as they wished.

We observed a person who had fallen from a chair not being attended to by staff in a timely way. However, we saw other incidents when staff acted promptly, following correct procedures. People were offered support to use the facilities in the home. Monitoring was in place for people who chose to remain in their rooms. However, for those who may have been able to use the call bells without any risks, this had not been considered on an individual basis. This may have improved privacy and dignity for some people and given more independence and choice.

Feedback from staff was mixed in relation to feeling supported and valued at work. Whilst some staff felt the direction and culture within the service was driving improvement, others felt this was not a shared direction or positive culture. The provider has told us they are committed to an inclusive culture for all.

The supervision process was not used effectively to cascade and nurture the shared direction of the service and foster a culture of an open inclusiveness to drive improvements and personal development. The registered manager told us they held staff meetings. We saw evidence of monthly clinical meetings taking place and daily handovers. Some staff told us they attended these meetings, but others said they had never been involved. The registered manager operates an ‘employee of the month’ to help with promoting a positive culture in the service recognising staff achievements.