This unannounced inspection took place on 24 and 25 October 2017. At out last inspection on 6, 7 and 10 April 2017 we had found considerable concerns about the systems used to assess and monitor risk which had impacted negatively on people’s care. Quality assurance checks were not effective at identifying the concerns we found. We found serious breaches of regulations around the governance of the home. We also identified five other breaches of regulations in relation to safeguarding people from neglect, medicines management, staffing, staff training and involving people or their relatives in decisions about their care. The home was rated Inadequate overall and placed in special measures.Some incidents were brought to the attention of the local authority and clinical commissioning group (CCG), by the home and CQC during this inspection and a provider concerns process was put in place. The provider had placed a voluntary restriction on new admissions during this period
We had served a warning notice in respect of the more serious breaches found in relation to the governance of the home. We had carried out a focused inspection on 25 and 26 July 2017 to check that improvements to these more serious concerns had been addressed. We found some improvements had been made.
We carried out this inspection in line with our special measures guidance and to check that sufficient progress had been made to reduce risks and meet all the fundamental standards.
Bromley Park Dementia Nursing Home is a care home that specialises in care and support for people living with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 50 people in one adapted building. At the time of the inspection there were 27 people living at the home.
There was a registered manager in post and a new manager had just come to work at the home. 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 2008 and associated Regulations about how the service is run.
There had been a considerable amount of change required. At this inspection on 24 and 25 October 2017 we found considerable improvements had been made across all key questions.
However, there remained some room for improvement to ensure the changes were consistently embedded at the home over time. We found that most risks to people were identified assessed and monitored well. However, we found a breach of regulation as some changes in risk for some people had not always been identified or monitored or guidance provided to staff. For example the need for a call bell had not been identified for one person or the need for a wound care plan for another person. You can see the action we have asked the provider to take at the back of the full version of this report.
Records related to risk had improved and the registered manager was working to monitor and ensure improvements became embedded. Care plans needed some improvement to ensure accuracy and that people’s needs were reflected consistently in the care plan.
Leadership at the home had improved significantly and we found this had improved outcomes for people. Most people could not express a view about their care but feedback we received from relatives, visitors and professionals confirmed that they had noticed considerable improvements to the quality of care provided. We observed the culture of the home had changed and care was now more directed by the needs of people and the aim to provide personalised care. There was a range of meetings to ensure effective communication between staff at the home and people’s views were sought through regular residents and relatives meetings and surveys.
There were significant improvements to people’s care. People and their relatives told us they felt safe and well cared for. Staff knew how to identify and respond to any safeguarding concerns. We saw people felt comfortable in staff presence and interactions were positive. Medicines were safely managed. There were now enough staff to meet people’s needs and there had been a significant increase in permanent staff. Recruitment processes were effective to ensure suitable staff were recruited.
Improvements had been made to staff training and development through champion and senior care worker roles.
People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Improvements had been made to the way people’s dietary needs were met and a range of health professionals were available to support their health needs.
People and their relatives told us they were treated with dignity and respect and they were now more involved in their care planning. Complaints were managed appropriately.
There were some very good elements to the care provided. Non-care staff were seen to interact with people in a warm and knowledgeable way. There was a wide range of activities provided that engaged people and the activities coordinators promoted personalised sensitive care.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.