Brompton House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found 3 breaches of regulation in relation to people's safe care and treatment and protecting people from abuse and improper treatment and staffing. Not all safeguarding incidents were reported to the local authority and to Care Quality Commission. Some acts of omissions and neglect in management of medicines were identified but not reported internally or externally, and not investigated. This was not in line with the providers policies. People did not always receive their medicines safely and as prescribed. Staff were not always deployed in a way that ensured people's health and wellbeing. Some of the unused bedrooms were cluttered and posed a fire hazard. Staff training was not always up-to-date and there was insufficient evidence of an action plan to address this or mitigation of risk in the meantime. Some of the agency staff did not have portfolios listing their qualifications and background checks while other agency staff did not have any induction folder.

This service scored 41 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not always experience a positive culture, where staff and the management team learned from mistakes. We could only speak to a small number of people living within the service as lot of people had advanced dementia and this impacted their understanding of what we were asking. Some people did not know the registered manager, and they told us they would raise their concerns with staff. We spoke to relatives of people within the service and they all said they knew how to raise concerns and they felt able to raise concerns but there was a mix of responses of whether these concerns had been addressed or not.

Staff and leaders did not promote an open proactive culture to safeguarding incidents and medicines errors. Safeguarding incidents and medicines errors were not always reported or investigated which resulted in failures to learn lessons and continually embed good practice. There was not an open or positive culture at the service. Concerns reported by staff to the leadership were not always listened or acted upon. As the provider failed to identify issues and concerns, and there was poor oversight of accidents, incidents and safeguarding, this placed people at the continued risk of harm, including potentially avoidable events.

During the assessment, we identified multiple concerns. We reported these concerns to the senior management team. There were ineffective processes to ensure lessons were learnt and improvements were then made. A week after our visit the service was visited by Integrated Care Board (ICB) who identified concerns regarding lack of clinical oversight, conflicting information in people’s care plans and gaps in repositioning monitoring charts.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us they felt safe. One person told us, “I do feel safe. I don’t know why, I just feel safe.” Another person said, “I am happy and settled here. I think I am safe.” Relatives told us they understood how to raise any abuse concerns they may have. Relatives we spoke with told us they felt their loved ones were safe being supported by staff and did not have concerns about their safety.

The senior management of the service was not clear on their safeguarding responsibilities. When we requested the management to review their medicines incidents and report them as safeguarding incidents, the area director told us that according to their policy only medicines incidents resulting in harm were reportable as safeguarding incidents. However, this contradicted the provider’s policy. Following our assessment visit, we raised a safeguarding referral regarding 2 medicines-related incidents that met safeguarding criteria under the provider’s policy, but were not submitted by the service. Staff interviewed told us they would report any suspected abuse to the manager, and if they did not act upon their concerns they would escalate it further. Staff told us they would inform the local safeguarding team and Care Quality Commission (CQC).

During our assessment we saw that staff were caring and spoke with people in a respectful and dignified manner. They had a good understanding of people’s needs and how to promote and maintain their safety, for example by using appropriate equipment to ensure people safely transferred and mobilised.

There was an appropriate safeguarding policy in place. However, statutory notifications had not always been submitted to CQC or the local authority had not been alerted to potential safeguarding incidents. For example, one person had finger marks recorded on their body map. The person’s daily notes stated they had disclosed that one of the carers had been rough with the person during personal care. We were not informed about this incident. The provider acted on our feedback and submitted a safeguarding referral following our inspection.

People and their relatives provided us with mixed feedback regarding their involvement in risk management. One person told us that staff were keen to assist them, however, they chose to remain in their bedroom due to their discomfort. The person told us, "I wouldn't want to risk fall again." Some people's relatives told us they were unsure if their suggestions to minimise risks such as risk of developing pressure sores were listened by the management of the service.

Staff demonstrated a good understanding of people's needs and how risks were managed. However, during this assessment we found examples where risk assessments and care plans were not robust. We were not assured the registered manager knew all individual risks within the home. The registered manager gave inspectors incorrect information in relation to people’s clinical needs. For example, one person did not have a catheter as we were told by the registered manager.

We observed people were regularly supported to have drinks and people had their walking aids placed next to them by staff when they were sat in the lounge. Where people had pressure mattresses these were set to the correct weight of the person. However, some sensor alarm mats were positioned too far away from people, and staff would not always be alerted if someone had a fall.

Some people's care plans lacked clear guidance for staff about their role in monitoring and providing a consistent approach. For example, one person’s specific health needs assessment lacked information about risks and symptoms related to their health needs. The instructions for staff to follow up were very general, for example ‘Administer food as appropriate, administer (medicine) as appropriate’, without explaining what is appropriate for this person. In the other part of the specific health assessment staff were instructed to monitor the person for soft signs of their health condition, however, the assessment did not specify any signs or symptoms staff should be aware of.

People told us that the environment was clean and well maintained. People’s personal possessions were welcomed to create more familiar and homely environment in their rooms. People told us they were comfortable being supported by staff if they had mobility needs.

On 28 September we saw that unused bedrooms were cluttered and posed a fire risk hazard. The fire door to the maintenance room was blocked with a bag of cement. We reported this to the management of the service who told us that this issue had already been identified and they were in process of removing the clutter from the unused bedrooms. We returned to the service on 3rd September 2024 and we asked staff to open the bedrooms we had checked before to find out that they were not de-cluttered and still posed a serious fire risk. The fire door leading to the maintenance room was blocked with a bucket of paint. This showed that staff and leaders lacked the awareness and understanding to address environmental risks. Following our visit we submitted a referral to the fire and rescue service. The service was visited 3 weeks after our visit by a Fire Officer who informed us that that the immediate risk highlighted by CQC inspectors was satisfactorily dealt with.

Some areas of the environment were not always clean or safe. For example, on the first day of our inspection we saw that kitchen was not always clean. On the second day of our assessment we saw that not all COSHH products were locked away to prevent people from accessing them. On the first day of our assessment we noted a tall, broken free-standing fridge-freezer in a communal corridor. This posed a serious health and safety risk if any of people decided to move the fridge-freezer. We reported this to the management of the service who took immediate action and removed the fridge-freezer.

Processes did not support a safe environment. We identified multiple risks and timely action was not taken to address risks. There were gaps in health and safety checks. For example, a gap in weekly fire checks, gaps in the monthly high risk electrical equipment register, profiling bed checks and room checks.

Not all people were supported with their care needs in a timely way. People and their relatives told us this was due to changes in staff rotas. Some people told us that the recent change in the shift pattern caused chaos and affected the time they received personal care. During our visit we saw that some people waited for staff to assist them with personal care. One person told us, “I am waiting to be dressed. I don’t know where they (carers) are.” Another person told us, “Between 6.30 a.m. and 8.15 a.m. it is chaos. I got into the habit of using my call bell before 6.30 a.m. if I wanted (to go to toilet) or a cup of tea, otherwise you wouldn’t see anyone until 9 a.m. or 9.30 a.m. There are always people around after that.”

Staff told us there were not enough of them to support people. We found that 5 people reviewed were assisted only with bed wash. There was no evidence of people having had a bath or a shower for the last 16 days prior to our inspection. We heard that staff did not offer any choice to people but said, “We are going to wash you in bed, OK?”. When asked during staff interviews, staff told us they were not given enough time to offer a shower or a bath to people. A member of staff told us, “We have to share time with others to have a break. There are too many people to get up for the staff we have on shift.” Some staff told us they had not received proper induction before starting performing their tasks. A member of staff told us, “I had no training or mentoring, it all happened so fast, I had no time for learning, I felt under pressure not to make a mistake.” Following our assessment visit the member of staff was provided with additional training and completed full induction.

We started our assessment visit on the evening of 28 August 2024 and at the beginning of our inspection we saw 5 residents present in the lounge at 9 p.m. At 10 p.m. one of the residents told an inspector that they wanted to go to bed and had been waiting for staff for an hour, however, due to the staffing levels it was impossible to assist them to bed. Medicines were still being administered to the resident when inspectors left around 11 p.m. We saw that during our visit on 29 August staff were not rushed and had time to complete their tasks. However, staffing levels were different from those scheduled on the rota, and there was 1 additional member of staff. In spite of increased staffing numbers, people were still not offered baths or showers. One of the staff members told us they were not supposed to work on the day of our visit but were asked to come to work.

Processes did not support safe staffing levels. Staff deployment was not always appropriate to the time of day and resident needs. Staff were recruited safely. Recruitment files showed all pre-employment checks had been made to ensure only staff who were suitable to work with people were employed. People received care and support from experienced staff who had not always completed their mandatory training. For example, only half of the staff were compliant with the fire drill and only 63% of staff administering medicines completed their annual competency checks. The provider's dependency tool did not always accurately reflect people's needs. Relevant processes were not always followed with agency staff. Some agency staff had their portfolios but did not have any evidence of their induction. There were induction files without matching agency portfolios. Some induction folders were incomplete with only first names of people who completed induction.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People provided us with mixed feedback regarding timing of their medicines administration. People told us staff supported them with their medicines. People said they had the right medicines but did not always receive them at the right time. Some people were prescribed medicines for pain management, and anticipatory medicines for palliative care to be given on a ‘when required’ basis. However, person-centred guidance in the form of medicines administered when required (PRN) protocols was not always in place to give these medicines consistently. There was evidence that out-of-date over-the-counter medicine held in stock had been administered to people putting them at risk of harm. People were given their medicines by staff as prescribed; this was recorded on their electronic medicines administration record (MAR) by the staff. Appropriate assessment was carried out to enable people to self-administer their medicines.

Staff received training to handle medicines safely. However, staff did not always follow the providers policy to check the medicines and medical devices held in stock. Staff informed us the computer equipment provided for electronic medication administration records was not working as intended.

Medicines were not always managed safely. Medicines including controlled drugs were stored securely and at recommended temperatures. However, we found out-of-date medical devices and prescribed eye drops stored with current medicines. This meant there was a risk of these devices and eye drops to be used, putting people at risk of harm. We found evidence of out-of-date over-the-counter medicines held in stock to have been administered by the staff. This meant that the date-checking process was not effective. There were electronic medicines administration records (MARs) in place. However, the computer equipment being used was very slow which led to delays in accessing the records while administering medicines. Regular medicines audits were carried out; however, the audits had failed to identify the concerns we found during the assessment. On 28 August we found some medicines that were left in a nursing office. The medicines were not checked in and administered, as information about the medicines was not passed to the next shift during handover. This resulted in a delay in administering medicines. Medicines policies were in place. There was a process in place to receive and act on medicine alerts.