Brompton House Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

There was a lack of effective clinical oversight and governance to ensure people received care and treatment that met their assessed needs. There was a closed culture and a culture of blame. Some staff told us they were penalised for speaking up. The provider’s internal whistleblowing procedure was not effective and whistleblowings did not always remain confidential. Some medicines errors identified were not reported externally or internally. We identified a breach related to good governance during this assessment.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were unable to share the strategy, values and vision of the service or their understanding of what the culture was like. They told us they did not understand the direction and values of the service basing on their own work experience. There was a proportion of the staff team that did not feel included and empowered to speak openly in the workplace. We were told there was a closed culture and that the management “targeted” staff if they raised issues about how they provided care to people. We told the senior management about these concerns during the assessment visit, but we continued to receive similar concerns after our visit.

The provider did not have effective systems that assessed or monitored the day-to-day culture of the service, and this meant they had not identified the warning signs of a closed culture noted during the inspection. Staff told us they used formal processes to raise their concerns and records confirmed this. However, the processes in place did not support effective resolution.

Staff provided mixed but mostly negative feedback about the openness of senior leaders. A member of staff told us, “Before they were more approachable, they didn't shout at you. Now (registered manager) feels offended if we challenge her, so we just stand back and let her continue.” During our staff interviews some staff broke up in tears when providing us with the feedback about the leadership of the service. One member of staff told us, “They are trying to make us scared as they are saying we will lose our job.” The management of the service did not always act on our feedback. For example, we reported to them our concerns related to unused bedrooms being cluttered on the first day of our visit. We found that our concerns remained unaddressed on the third day of our assessment visit.

The leaders of the service did not ensure consistent good practice was in place across the service resulting in shortfalls and breaches of our regulations. During our assessment visits we were repeatedly provided with misleading information by the leadership of the service. Some people did not know who the registered manager of the service was. We sought assurance from the provider as to actions they were taking following our assessment visit. We expressed our concerns about the leadership of the service to the senior management. The provider agreed that the current leadership did not perform well and told us they were planning changes within the management team to drive improvements. However, there were no changes introduced following our assessment visit.

Staff shared their concerns of not feeling safe to speak up. Some staff told us they stopped reporting medicines incidents due to their fear of retaliation from the leadership of the service. A member of staff told us, “They are targeting people who raised concerns. Sometimes I think it is personal.” This resulted in shortfalls in transparency and staff not reporting concerns. This meant medicines errors had not always been fully investigated, risks mitigated, or lessons learnt. Prior and during the assessment process we received whistleblowings from staff who did not feel the provider would listen or act if they were to go to them with their concerns. Prior to our inspection we received a whistleblowing signed by 23 members of staff who felt unable to speak up directly to the provider. 21 out of 23 members who signed the whistleblowing were subjected to performance management within the last 2 years. Some staff told us that performance management was used as a punishment for speaking up by the leadership of the service.

Systems designed to gather feedback from people and staff had failed to identify significant concerns about the culture of the service where staff did not feel able to be open when things went wrong. The provider’s whistleblowing policy has not always been followed, and the whistleblowings did not always remain confidential. Staff used an internal whistleblowing service to report their concerns. This was supposed to remain anonymous, however, the details of this whistleblowing concern were reported to the registered manager with the name of the whistleblower. The whistleblower emailed the area manager complaining that their details leaked to the registered manager. The whistleblower never received any response to their complaint.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Feedback from staff and leaders across the organisation at all levels did not provide assurance or evidence of robust, effective or well-embedded governance and oversight measures. Staff told us some medicines errors were not recorded and reported internally. They also told us that the leadership of the service did not always take any action when they reported bad practice. A member of staff told us, “We reported a nurse signing off meds without seeing residents swallowing it, but nothing happened. Some staff are not being treated fairly.”

Quality assurance processes were poor and systems were not well established and monitored to ensure safe and good quality care. There was no evidence of the provider’s effective oversight in areas such as safeguarding, staffing, culture, or management of medicines. Medicine audits, safeguarding audits, health and safety audits and care plan audits were not always effective in identifying concerns. Sometimes issues identified by the registered manager were not recorded and not reported internally or externally.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Leaders did not demonstrate a good understanding of identifying and actioning continuous improvement in the quality of the service. Feedback from staff and leaders did not demonstrate a focus on continuous learning, innovation and improvement across the organisation and the local system.

The provider did not demonstrate how the service learned and improved following our assessment feedback. There was a negative culture at the home. Staff meetings and supervisions were not effective because staff told us they did not feel supported by the management team. Staff told us management were not always responsive when they raised concerns in relation to people’s health.